Legacy Vision

6909 Coit Road, Suite 200
Plano, TX 75024
phone: 972.208.5757
fax: 972.208.5548
email us


We are located at the South West corner of Coit and Legacy. In the Sprouts shopping Center

HOURS

Tue, Thu-Fri 9:00am - 6:00pm
Wed 9:00am - 5:00pm
Sat 9:00am - 3:00pm

Eye Care

Children's Vision

Are Contact Lenses a Good Choice for Kids

A common question many parents have about contact lenses and kids is: "When is my child old enough to wear contact lenses?"

Physically, your child's eyes can tolerate contact lenses at a very young age. Some babies are fitted with contact lenses due to eye conditions present at birth. And in a recent study that involved fitting nearsighted children of ages 8-11 with one-day disposable contact lenses, 90% had no trouble applying or removing the contacts without assistance from their parents.

A matter of maturity

So the important question is whether or not your child is mature enough to insert, remove and take care of their contact lenses. How they handle other responsibilities at home will give you a clue. If your child has poor grooming habits and needs frequent reminders to perform everyday chores, they may not be ready for the responsibility of wearing and caring for contact lenses. But if they are conscientious and handle these things well, they may be excellent candidates for contact lens wear, regardless of their age.

Contact lenses for sports

Many kids are active in sports. Contact lenses offer several advantages over glasses for these activities. Contacts don't fog up, get streaked with perspiration or get knocked off like glasses can. They also provide better peripheral vision than glasses, which is important for nearly every sport. There are even contact lenses with special tints to help your child see the ball easier.

For sports, soft contact lenses are usually the best choice. They are larger and fit closer to the eye than rigid gas permeable (GP) lenses, so there's virtually no chance they will dislodge or get knocked off during competition.

Controlling nearsightedness

If your young son or daughter is nearsighted, rigid gas permeable (GP) contacts may be the best choice. In some cases, GP contact lenses may slow the progression of myopia in children. (Soft lenses don't offer this potential benefit.) Also, GP lenses are more durable and often provide sharper vision than soft contacts.

Building self-esteem with contact lenses

Contact lenses can do wonders for some children's self-esteem. Many kids don't like the way they look in glasses and become overly self-conscious about their appearance because of them. Wearing contact lenses can often elevate how they feel about themselves and improve their self confidence. Sometimes, even their school performance and participation in social activities improves after they switch to contact lenses.

Glasses are still required

If your child chooses to wear contact lenses, they still need an up-to-date pair of eyeglasses. Contact lenses worn on a daily basis should be removed at least an hour before bedtime to allow the eyes to "breathe." Also, there will be times when your child may want to wear their glasses instead of contact lenses. And contact lenses should be removed immediately any time they cause discomfort or eye redness.

Don't push contacts on your kids

Motivation is often the most important factor in determining whether your son or daughter will be a successful contact lens wearer. If you wear contact lenses yourself and love them, that still doesn't mean they are the right choice for your child. Some children like wearing glasses and have no desire wear contact lenses.

We can usually tell at your child's contact lens consultation if they really want to wear contact lenses. If it appears that they would rather stay in glasses, we will certainly respect their decision – and you should, too.

Sometimes it's just a matter of timing. Often, a child may feel they don't want contacts, but a year or two later, they do. There's always time to make that decision.

When your child is ready to try contacts

When you and your child agree it's time for contacts, call our office to schedule a contact lens consultation. We welcome the opportunity to help kids of all ages enjoy wearing contact lenses.

For more information on contact lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

Children's Vision FAQs

Q: How often should children have their eyes examined?

A: According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. After that, kids should have routine eye exams at age 3 and again at age 5 or 6 (just before they enter kindergarten or the first grade).

For school-aged children, the AOA recommends an eye exam every two years if no vision correction is needed. Children who need eyeglasses or contact lenses should be examined annually.

Q: My 5-year-old daughter just had a vision screening at school and she passed. Does she still need an eye exam?

A: Yes. School vision screenings are designed to detect gross vision problems. But kids can pass a screening at school and still have vision problems that can affect their learning and school performance. A comprehensive eye exam by an optometrist can detect vision problems a school screening may miss.  Also, a comprehensive eye exam includes an evaluation of your child's eye health, which is not part of a school vision screening.  

Q: What is vision therapy?

A: Vision therapy (also called vision training) is an individualized program of eye exercises and other methods to correct vision problems other than nearsightedness, farsightedness and astigmatism. Problems treated with vision therapy include amblyopia ('lazy eye"), eye movement and alignment problems, focusing problems, and certain visual-perceptual disorders. Vision therapy is usually performed in an optometrist's office, but most treatment plans also include daily vision exercises to be performed at home.

Q: Can vision therapy cure learning disabilities?

A: No, vision therapy cannot correct learning disabilities. However, children with learning disabilities often have vision problems as well. Vision therapy can correct underlying vision problems that may be contributing to a child's learning problems. 

Q: Our active 1-year-old boy needs glasses to correct his farsightedness and the tendency for his eyes to cross. But he pulls them off the second they go on. We've tried an elastic band, holding his arms, tape... He just struggles and cries. How do we get him to wear his glasses?

A: In most cases, it just takes awhile for a toddler to get used to the sensation of wearing glasses. So persistence is the key. Also, you may want to put his glasses on as soon as he wakes up – this will usually help him adapt to the glasses easier.

But it's also a good idea to recheck the prescription and make sure his glasses were made correctly and are fitting properly. Today, there are many styles of frames for young children, including some that come with an integrated elastic band to help keep them comfortably on the child's head. Bring your son and the eyewear to our office. Even if you didn't purchase the glasses from us, we will be happy to give you our opinion about why your son is having a tough time wearing them and what you can do about it.

Q: Our 3-year-old daughter was just diagnosed with strabismus and amblyopia. What are the percentages of a cure at this age?

A: With proper treatment, the odds are very good. Many researchers believe the visual system can still develop better visual acuity up to about age 8 to 10. If your daughter's eye turn (strabismus) is constant, it's likely surgery will be necessary to straighten her eyes in order for her therapy for amblyopia (or "lazy eye") to be successful. Strabismus surgery may be needed even if her eyes alternate in their misalignment. See a pediatric ophthalmologist who specializes in strabismus surgery for more information.

Q: My daughter (age 10) is farsighted and has been wearing glasses since age two. We think she may have problems with depth perception. How can she be tested for this, and if there is a problem, can it be treated?

A: We can perform a very simple stereopsis test to determine if your daughter has normal depth perception. In this test, she wears "3-D glasses" and looks at a number of objects in a special book or on a chart across the room. If she has reduced stereopsis, a program of vision therapy may help improve her depth perception.

Q: We have an 11-year-old son who first became nearsighted when he was 7. Every year, his eyes get worse. Is there anything that can be done to prevent this?

A: Rigid gas permeable (GP) contact lenses may help. Research shows that, in many cases, fitting myopic youngsters with GP lenses may slow the progression of their nearsightedness. There's also a special fitting technique with GP contacts called orthokeratology (or "ortho-k") that can even reverse certain amounts of myopia. There is also research that suggests bifocals and/or reading glasses may slow down the progression of myopia in some children.

Q: My 7-year-old son's teacher thinks he has "convergence insufficiency." What is this, and what can I do about it?

A: Convergence insufficiency (CI) is a common learning-related vision problem where a person's eyes don't stay comfortably aligned when they are reading or doing close work. For reading and other close-up tasks, our eyes need to be pointed slightly inward (converged). A person with convergence insufficiency has a tough time doing this, which leads to eyestrain, headaches, fatigue, blurred vision and reading problems. Usually, a program of vision therapy can effectively treat CI and reduce or eliminate these problems. Sometimes, special reading glasses can also help.

Q: My son is 5 years old and has 20/40 vision in both eyes. Should I be concerned, or could this improve with time?

A: Usually, 5-year-olds can see 20/25 or better. But keep in mind that visual acuity testing is a subjective matter – during the test, your child is being asked to read smaller and smaller letters on a wall chart. Sometimes, kids give up at a certain line on the chart when they can actually read smaller letters. Other times, they may say they can't read smaller letters because they want glasses. (Yes, this happens!) Also, if your son had his vision tested at a school screening (where there can be plenty of distractions), it's a good idea to schedule a comprehensive eye exam to rule out nearsightedness, astigmatism or an eye health problem that may be keeping him from having better visual acuity.

Q: My daughter has been diagnosed with refractive amblyopia due to severe farsightedness in one eye. She just got her glasses and the lens for her bad eye is much thicker than the other lens. She complains that the glasses make her dizzy and she refuses to wear them. Can anything be done about this?

A: In situations like this, where one eye needs a much stronger correction than the other, contact lenses are a better option. With glasses, the unequal lens powers cause an unequal magnification effect, so the two eyes form images in the brain that are different in size. This can cause nausea, dizziness because the brain may not be able to blend the two separate images into a single, three-dimensional one. And, of course, the glasses will be unattractive because one lens will be much thicker than the other.

Even if your child is quite young, she can probably handle contact lens wear. Contact lenses don't cause the differences in image magnification that glasses do. Continuous wear lenses (worn day and night for up to 30 days, then discarded) or one-day disposable lenses may be good options.

Keep in mind that amblyopia is a condition where one eye doesn't see as well as the other, even with the best possible correction lens in place. Simply wearing the contacts may not improve the vision in her weak eye. Usually a program of vision therapy will also be needed.

For more information on children's vision or eye exams, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Controlling Nearsightedness in Children

Myopia (nearsightedness) is a common vision problem affecting children who can see well up close, while distant objects are blurred. Nearsighted children tend to squint to see distant objects such as the board at school. They also tend to sit closer to the television to see it more clearly.

Sometimes, childhood myopia can worsen year after year. This change can be disconcerting to both children and their parents, prompting the question: "Will it ever stop? Or, someday will this get so bad that glasses won't help?"

Myopia that develops in childhood nearly always stabilizes by age 20. But by then, some kids have become very nearsighted. Here are three possible ways to slow down the progression of myopia in children:

Gas permeable contact lenses

Wearing rigid gas permeable contact lenses (also referred to as "RGP" or "GP" lenses) may slow the progression of nearsightedness in children. It's been proposed that the massaging action of the rigid GP lens on the eye during blinking may keep the eye from lengthening, thereby reducing the tendency for advancing nearsightedness.

In 2001 to 2004, the National Eye Institute (NEI) conducted a controlled study to determine whether wearing GP lenses is effective in slowing the progression of myopia in children. The 116 participants in the study were 8 to 11 years old when the research began.

At the end of the three-year study period, the children who wore GP lenses had only 0.63 diopter (D) less nearsightedness than the kids in the control group who wore soft contact lenses.

The study also found that wearing GP lenses does not slow the growth of the eye, which causes most of the myopia in children. The reduced progression of myopia among those children wearing GP lenses was due only to the effect the lenses had on the front surface of the eye (the cornea). Children who wore the GP lenses had less increase in corneal curvature than those who wore soft contact lenses. The NEI researchers believe these GP lens-induced changes in corneal curvature are not likely to be permanent, and therefore the effect of GP lenses on controlling myopia progression may not be permanent.  

Orthokeratology

Orthokeratology, or "ortho-k," is the use of specially-designed gas permeable contact lenses to flatten the shape of the cornea and thereby reduce or correct mild to moderate amounts of nearsightedness. The lenses are worn during sleep and removed in the morning. Though temporary eyeglasses may be required during the early stages of ortho-k, many people with low to moderate amounts of myopia can see well without glasses or contact lenses during the day after wearing the corneal reshaping lenses at night.

Recent research suggests ortho-k may also reduce the lengthening of the eye itself, indicating that wearing ortho-k lenses during childhood may actually cause a permanent reduction in myopia, even if the lenses are discontinued in adulthood.

Bifocals

Some evidence suggests wearing eyeglasses with bifocal or progressive multifocal lenses may slow the progression of nearsightedness in some children. The mechanism here appears to be that the added magnifying power in these lenses reduces focusing fatigue during reading and other close work, a problem that may contribute to increasing myopia.

A five-year study published in the February 2007 issue of Investigative Ophthalmology & Visual Science produced an interesting result involving nearsighted children whose mother and father were also nearsighted.  These children, who wore eyeglasses with progressive multifocal lenses during the course of the study, had less progression of their myopia than similar children who wore eyeglasses with regular, single vision lenses.

See us for a consultation

If you are concerned about your child becoming more nearsighted year-to-year, call us to schedule a comprehensive eye exam and consultation. We can evaluate the progression of their myopia and discuss the best treatment options with you.

For more information on GP contact lenses or myopia, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Learning-Related Vision Problems

There's no question that good vision is important for learning. Experts say more than 80% of what your child is taught in school is presented to them visually.

To make sure your child has the visual skills they need for school, the first step is to make sure your child has 20/20 eyesight and that any nearsightedness, farsightedness and/or astigmatism is fully corrected with glasses or contact lenses. But there are other, less obvious learning-related vision problems you should know about as well.

Good vision is more than 20/20 visual acuity

Your child can have "20/20" eyesight and still have vision problems that can affect their learning and classroom performance. Visual acuity (how well your child can see letters on a wall chart) is just one aspect of good vision, and it's not even the most important one. Many nearsighted kids may have trouble seeing the board in class, but they read exceptionally well and excel in school.

Other important visual skills needed for learning include:

  • Eye movement skills – How smoothly and accurately your child can move their eyes across a printed page in a textbook.
  • Eye focusing abilities – How well they can change focus from far to near and back again (for copying information from the board, for example).
  • Eye teaming skills – How well your child's eyes work together as a synchronized team (to converge for proper eye alignment for reading, for example).
  • Binocular vision skills – How well your child's eyes can blend visual images from both eyes into a single, three-dimensional image.
  • Visual perceptual skills – How well your child can identify and understand what they see, judge its importance, and associate it with previous visual information stored in their brain.
  • Visual-motor integration – The quality of your child's eye-hand coordination, which is important not only for sports, but also for legible handwriting and the ability to efficiently copy written information from a book or chalkboard.

Deficiencies in any of these important visual skills can significantly affect your child's learning ability and school performance.

Many kids have vision problems that affect learning

Many kids have undetected learning-related vision problems. According to the College of Optometrists in Vision Development (COVD), one study indicates 13% of children between the ages of 9 and 13 suffer from moderate to severe convergence insufficiency (an eye teaming problem that can affect reading performance), and as many as one in four school-age children may have at least one learning-related vision problem.

Signs and symptoms of learning-related vision problems

There are many signs and symptoms of learning-related vision disorders, including:

  • Blurred distance or near vision, particularly after reading or other close work
  • Frequent headaches or eye strain
  • Difficulty changing focus from distance to near and back
  • Double vision, especially during or after reading
  • Avoidance of reading
  • Easily distracted when reading
  • Poor reading comprehension
  • Loss of place, repetition, and/or omission of words while reading
  • Letter and word reversals
  • Poor handwriting
  • Hyperactivity or impulsiveness during class
  • Poor overall school performance

If your child exhibits one or more of these signs or symptoms and is having problems in school, call us to schedule a comprehensive children's vision exam.

Comprehensive children's vision exam

A comprehensive children's vision exam includes tests performed in a routine eye exam, plus additional tests to detect learning-related vision problems. These extra tests may include an assessment of eye focusing, eye teaming, and eye movement abilities (also called accommodation, binocular vision, and ocular motility testing). Also, depending on the type of problems your child is having, we may recommend other testing, either in our office or with a children's vision and/or vision development specialist.

Vision therapy

If it turns out your child has a learning-related vision problem that cannot be corrected with regular glasses or contact lenses, then special reading glasses or vision therapy may help. Vision therapy is a program of eye exercises and other activities specifically tailored for each patient to improve their vision skills.  

Vision and learning disabilities

A child who is struggling in school could have a learning-related vision problem, a learning disability or both. Vision therapy is a treatment for vision problems; it does not correct a learning disability. However, children with learning disabilities may also have vision problems that are contributing to their difficulties in the classroom.

After your child's comprehensive vision exam, we will advise you about whether a program of vision therapy would be helpful. If we don't provide the services we believe your child needs, we will refer you to a children's vision specialist or education/learning specialist who does.

For more information on children's vision, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Vision Therapy for Children

Many children have vision problems other than simple refractive errors such as nearsightedness, farsightedness and astigmatism. These "other" vision problems include amblyopia ("lazy eye"), eye alignment or eye teaming problems, focusing problems, and visual perceptual disorders. Left untreated, these non-refractive vision problems can cause eyestrain, fatigue, headaches, and learning problems.

What is vision therapy?

Vision therapy (also called orthoptics or vision training) is an individualized program of eye exercises and other methods to treat non-refractive vision problems. The therapy is usually performed in an optometrist's office, but most treatment plans also include daily visual tasks and eye exercises to be performed at home.

Optometrists who specialize in vision therapy and the treatment of learning-related vision problems are sometimes called behavioral optometrists or developmental optometrists.

Can vision therapy eliminate the need for glasses?

Vision therapy is NOT the same as self-help programs that claim to reduce refractive errors and the need for glasses. There is no scientific evidence that these "throw away your glasses" programs work, and most eye care specialists agree they are a hoax.

In contrast, vision therapy is approved by the American Optometric Association (AOA) for the treatment of non-refractive vision problems, and there are many studies that demonstrate its effectiveness.

The degree of success achieved with vision therapy, however, depends on a number of factors, including the type and severity of the vision problem, the patient's age and motivation, and whether the patient performs all eye exercises and visual tasked as directed. Not every vision problem can be resolved with vision therapy.

Vision therapy is customized and specific

The activities and eye exercises prescribed as part of a vision therapy program are tailored to the specific vision problem (or problems) a child has. For example, if a child has amblyopia, the therapy usually includes patching the strong eye, coupled with visual tasks or other stimulation techniques to develop better visual acuity in the weak eye. Once visual acuity is improved in the amblyopic eye, the treatment plan may then include eye teaming exercises to foster the development of clear, comfortable binocular vision to improve depth perception and reading comfort.

Vision therapy and learning disabilities

Vision therapy does not correct learning disabilities. However, children with learning disabilities often have vision problems as well. Vision therapy can correct underlying vision problems that may be contributing to a child's learning problems. 

Be sure to tell us if your child has been diagnosed as having a learning disability. If we find vision problems that may be contributing to learning problems, we can communicate with their teachers and other specialists to explain our findings. Often, vision therapy can be a helpful component of a multidisciplinary approach to remediating learning problems.

Schedule a comprehensive eye exam

If you suspect your child has a vision problem that may be affecting their performance in school, the first step is to schedule a comprehensive eye exam so we can determine if such a problem exists. If learning-related vision problems are discovered, we can then discuss with you whether a program of vision therapy would be helpful.

If we don't provide the type of vision therapy your child needs, we will refer you to an optometrist who specializes in developmental vision and vision therapy.

For more information on vision therapy, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Your Infant's Visual Development

One of the greatest moments after the birth of your baby is the first time your newborn daughter or son opens their eyes and makes eye contact with you. But don't be concerned if that doesn't happen right away.

The visual system of a newborn infant takes some time to develop. In the first week of life, your newborn's vision is quite blurry, and they see only in shades of gray. It takes several months for your child's vision to fully develop.

Knowing the expected milestones of your baby's vision development during their first year of life can insure your child is seeing properly and enjoying their world to the fullest.

During your pregnancy

Your child's vision development begins before birth. How you care for your own body during your pregnancy is extremely important for the development of your baby's body and mind, including their eyes and the vision centers in their brain.

Be sure to follow the instructions your obstetrician (OB/GYN doctor) gives you regarding proper nutrition and the proper amount of rest during your pregnancy. And of course, avoid smoking and consuming alcohol or drugs during pregnancy, as these toxins can cause multiple problems for your baby, including serious vision problems.

At birth

At birth, your baby sees only in shades of gray. Nerve cells in their eyes and brain that control vision aren't fully developed. Also, their eyes don't have the ability to change focus and see close object clearly. So don't be concerned if your baby doesn't seem to be focusing on objects right away, including your face. It just takes time. (Despite these limitations, studies show that within a few days after birth, infants prefer looking at an image of their mother's face over anyone else's.)

The first month

Color vision develops in the first few weeks of life, so your baby is starting to see the world in full color. But visual acuity and eye teaming takes a bit longer -- so if your infant's eyes occasionally look unfocused or misaligned, don't worry.

The eyes of infants are not as sensitive to visible light as adult eyes are, but they need protection from the sun's harmful UV rays. Keep your baby's eyes shaded outdoors with a brimmed cap or some other means.

Months 2 and 3

Your baby's vision is improving and their two eyes are beginning to move better as a team. They should be following moving objects at this stage, and starting to reach for things they see. Also, infants at this stage are learning how to shift their gaze from one object to another without having to move their head. 

Months 4 to 6

By 6 months of age, significant advances take place in the vision centers of the brain, allowing your infant to see more distinctly, move their eyes faster and more accurately, and have a better ability to follow moving objects with their eyes.  

Visual acuity develops rapidly, improving from about 20/400 at birth to about 20/25 at six months of age. Your child's color vision should be nearly fully developed at age six months as well, enabling them to see all the colors of the rainbow with ease.

Children also develop better eye-hand coordination at 4 to 6 months of age. They're able to quickly locate and pick up objects, and accurately direct a bottle (and many other things) to their mouth.

Months 7 to 12

Your child is now mobile, crawling about and covering more distances than you might have expected. They are also better at judging distances and more skilled at locating, grasping and throwing objects, too.

During months 7 to 12, your child is developing a better awareness of their overall body and learning how to coordinate their vision with their body movements. At this time, watch them closely to keep them from harm as they explore their environment. Keep cabinets that contain cleaning supplies locked, and put a barrier in front of stairwells.

When its time for an eye exam

If you suspect something is seriously wrong with your baby's eyes in their first few months of life (a bulging eye, a red eye, excess tearing, or a constant misalignment of the eyes, for example) take your child to a pediatric ophthalmologist or other eye doctor immediately.

For routine eye care, the American Optometric Association (AOA) recommends you schedule your baby's first eye exam when they are six months old. Though your baby can't yet read letters on a wall chart, your optometrist can perform non-verbal testing to determine visual acuity, detect excessive or unequal amounts of nearsightedness, farsightedness and astigmatism, and evaluate eye teaming and alignment. At this exam, your doctor will also check the health of your baby's eyes, looking for anything that might interfere with normal and continuing vision development.

We welcome providing eye care for even the youngest children. For more information about eye exams for kids or to schedule your child's first eye exam, please call our office.

For more information on children's vision, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Computer Vision Syndrome

Children and Computer Vision Syndrome

Computer use has become a routine part of kids' lives.

Surveys show the average American child spends one to three hours daily on a computer while surfing the Internet, doing homework, talking online with friends and playing video games. About 90% of school-aged children in the U.S. have access to a computer at home or in school.

And kids are starting to use computers at a younger age. Among college students who were interviewed, 20% said they began using a computer before they were 9 years old.

A connection between computer use and myopia? 

So how is all this computer use at a young age affecting kids' eyes?

Many eye doctors who specialize in children's vision say sustained computer use puts kids at higher risk for childhood myopia (nearsightedness). They point out that, though myopia affects approximately 25% of the U.S. population, nearly 50% of adult computer users with a college education are nearsighted. Computer use, especially among youngsters whose eyes are still changing, may be the reason for this disparity.

Research seems to support this theory. A study of 253 children between the ages of 6 and 10 at the University of California at Berkeley School of Optometry found a strong correlation between the amount of time young children spend on the computer and their development of nearsightedness.

Why computers can be hard on kids' eyes 

Computer use stresses the eyes more than reading a book or magazine because it's harder to maintain focus on computer-generated images than on printed images.

This is especially true for young children, whose visual system is not fully developed.

According to the American Optometric Association, children may be especially vulnerable to computer-related vision problems because:

  • Children have a limited degree of self-awareness. They may perform a task on the computer for hours with few breaks. This prolonged activity can cause focusing and eyestrain problems.
  • Children assume that what they see and how they see is normal – even if their vision is impaired or slowly deteriorating.
  • Children are smaller than adults. Because computer workstations are often arranged for adult use, this can increase the risk of children sitting too near the screen or adopting unusual postures that can lead to eyestrain and neck, shoulder and back pain.

Tips for preventing Computer Vision Syndrome in children

To prevent your child from developing eyestrain and other CVS symptoms (including increasing myopia), follow these tips:

  1. Before they start school, make sure your kids have a comprehensive eye exam--including an assessment of their near-point (computer and reading) vision skills.
  2. Make sure your child's computer workstation is arranged to suit body size. For children, the recommended distance between the monitor and the eye is 18 to 28 inches to avoid risk of eyestrain with closer viewing. Also, the screen should be a few inches below the child's eyes. The chair should be adjusted so arms are parallel with the desk surface and feet rest comfortably on the floor. These adjustments help avoid posture problems and strained muscles.
  3. Be aware of the signs and symptoms of vision problems, such as eye redness, frequent rubbing of the eyes, head turns and other unusual postures or complaints of blurriness or eye fatigue. Avoidance of the computer or school work may also indicate a vision problem.

If you suspect your child may be developing a vision problem related to computer use, be sure to mention this when you make an appointment for an eye exam. Your doctor may want to set aside extra time to perform tests specifically designed to detect computer vision problems.

For more information on myopia and computer vision syndrome, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Computer Eyestrain: 10 Steps for Relief

With so many people using computers at work, eyestrain has become one of the leading office-related health complaints.

Experts estimate 50% to 90% of computer users experience some degree of eyestrain or other symptoms of computer vision syndrome (CVS) during their work day. Studies show eyestrain and CVS often cause fatigue, decreased productivity and more work errors.

So what can you do about it? Here are steps you (and your employer) can take to reduce computer eye strain and the other common symptoms of computer vision syndrome (CVS):

1. Get a computer eye exam.

This is the most important thing you can do to prevent computer vision problems. According to the National Institute of Occupational Safety and Health (NIOSH), computer users should have an eye exam before they start working on a computer and once yearly thereafter. Be sure to tell your eye doctor how often you use a computer at work and at home.

2. Use proper lighting.

Computer eyestrain is often caused by excessively bright ambient lighting — either from outdoor sunlight coming in through a window or from harsh interior lighting. For the most comfortable computer use, ambient lighting should be about half as bright as that found in most offices.

If possible, reduce the brightness of interior lighting by using fewer fluorescent tubes in overhead light fixtures or use lower intensity bulbs. If possible, position your monitor so that windows are to the side of it, instead of in front or back. Adjust window blinds to reduce the amount of sunlight entering your workstation.

3. Minimize glare.

Glare on walls and finished surfaces as well as reflections on the computer screen can also cause computer eyestrain. You may want to install an anti-glare screen on your monitor and, if possible, paint bright white walls a darker color with a matte finish.

Again, cover the windows. When outside light cannot be reduced, consider using a computer hood.

If you wear glasses, have an anti-reflective (AR) coating applied to your lenses. AR coating reduces glare by minimizing the amount of light reflecting off the front and back surfaces of your eyeglass lenses.

4. Upgrade your display.

If you've not already done so, replace your old tube-style monitor (called a cathode ray tube or CRT) with a flat-panel liquid crystal display (LCD), like those on laptop computers.

LCD screens are easier on the eyes and usually have an anti-reflective surface. Old-fashioned CRT screens can cause a "flicker" of images on the screen. Even if this flicker is imperceptible, it can still contribute to eyestrain and fatigue during computer work.

If you still use a CRT, you can decrease eyestrain from flicker by increasing the refresh rate of your screen to 75 hertz (Hz) or higher. You can access this setting in the Control Panel of your computer.

When choosing a new flat panel display, select a screen with the highest resolution possible. Resolution is related to the "dot pitch" of the display. Generally, displays with a lower dot pitch have sharper images. Choose a display with a dot pitch of .28 mm or smaller.

Finally, choose a relatively large display. For a desktop computer, select a display that has a diagonal screen size of at least 19 inches.

5. Adjust the brightness and contrast of your computer screen.

For more comfortable viewing, adjust the display settings on your computer so the brightness of the screen is about the same as your work environment.

As a test, try looking at the white background of this web page. If it looks like a light source, it's too bright. If it seems dull and gray, it may be too dark.

Also, adjust your screen settings to make sure the contrast between the screen background and the on-screen characters is high. And make sure that the text size and color are optimized for the most comfort. Usually, black text on a white background is the best color combination. But other high-contrast, dark-on-light combinations may also be acceptable.

6. Blink more often.

Blinking is very important — it rewets your eyes to keep them moist, comfortable and clear.

Studies show that, during computer use, most people blink only about 20% as frequently as they normally do. This greatly increases the risk for dry eyes, blurred vision, eye irritation and fatigue.

To keep your eyes comfortable and seeing well during computer use, try this exercise: Every 20 minutes, blink 10 times by closing your eyes as if falling asleep (very slowly). This will help rewet your eyes.

Also, keep a bottle of artificial tears at your workplace and use them to moisten your eyes often during prolonged computer use. Ask your eye doctor to recommend the best brands for your needs.

7. Exercise your eyes.

Another cause of computer eyestrain is focusing fatigue. Research shows that it's harder for our eyes to maintain focus on computer-generated images than on printed images in a book or magazine.

To reduce your risk of focusing fatigue during computer use, look away from your screen or monitor every 20 minutes and gaze at a distant object across the room. Looking far away relaxes the focusing muscles inside your eyes, reducing focusing fatigue.

Another exercise is to look far away at an object for 10-15 seconds, then gaze at something up close for 10-15 second--then look back at the distant object again. Do this 10 times. This exercise reduces the risk of your eyes' focusing system from "locking up" (a condition called accommodative spasm) during prolonged computer work.

8. Take frequent breaks.

Take frequent, short breaks from your computer work throughout the day. Stand up, walk away from your work station and stretch your arms, legs, back, neck and shoulders. These activities will reduce your risk for computer vision syndrome and neck, back and shoulder pain.

Many workers take only two 15-minute breaks from their computer during their work day. According to a recent NIOSH study, computer workers experienced significantly less discomfort and eyestrain if they took four additional 5-minute "mini-breaks" during the day.

Interestingly, these supplementary breaks did not reduce productivity. Data entry speed was significantly faster as a result of the extra breaks, so work output was maintained even though the workers had 20 extra minutes of break time each day.

9. Modify your workstation.

Looking back and forth between a printed page and your computer screen (as during data entry tasks), can also cause eyestrain. To improve comfort during these tasks, place the print material on a copy stand adjacent to your screen or monitor. If necessary, use a desk lamp to illuminate the print material--but make sure it doesn't shine into your eyes or onto the computer screen.

Improper posture during computer work also contributes to computer vision syndrome. Adjust your workstation and chair to a comfortable height so your feet are flat on the floor in front of you.

Adjust your chair and computer so your screen is approximately 20 to 24 inches from your eyes and slightly below eye level so you can view it comfortably with your head and neck in a natural position.

10. Consider computer eyewear.

For the greatest comfort at your computer, you may benefit from having a customized eyeglasses prescription for your computer work. This is especially true if you normally wear contact lenses, that can become dry and uncomfortable during sustained computer work.

Computer glasses are also a good choice if you normally wear eyeglasses with bifocal or progressive lenses. Though these lenses provide excellent vision for most tasks, they don't provide an adequate viewing zone for prolonged computer work.

Your eye doctor can prescribe specially-designed computer eyewear to give you the best possible vision at your computer screen.  Keep in mind that computer glasses are a specific type of eyewear and typically should not be worn when driving.

For more information on computer glasses and computer vision, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Computer Glasses

When you work at a computer for any length of time, it's common to experience blurred vision and other symptoms of computer vision syndrome (CVS). Viewing computer-generated print and images on a screen or monitor for prolonged periods is harder on the eyes than viewing a similar amount of material on the printed pages of a book or magazine.

If you're under age 40, blurred vision during computer use may be due to your eyes being unable to remain accurately focused on your screen for sustained periods. Or you may have a hard time quickly and accurately changing focus, such as when you shift your gaze from your monitor to your keyboard and back again. This problem, called lag of accommodation, can cause eyestrain and headaches — two common symptoms of CVS.

If you're over age 40, the onset of presbyopia — the normal age-related loss of near focusing ability — can make focusing on a computer screen even more difficult, further increasing the risk of eyestrain, headaches and eye fatigue.

So what can you do to make your eyes more comfortable and function more efficiently during computer use? Have your eye doctor prescribe specially-designed computer glasses.

Customized computer glasses can make a world of difference. These special-purpose glasses are prescribed specifically to reduce eyestrain and give you the most comfortable vision at your computer.

I already wear glasses. Do I really need computer glasses?

If you already wear prescription eyeglasses or reading glasses, you may be tempted to dismiss the idea of computer glasses. But eyeglasses prescribed for general purpose wearing are often not well-suited for prolonged computer work.

Why? When working at a computer, your eyes are generally 20 to 26 inches from your computer screen. This distance is considered the intermediate zone of vision — closer than driving (distance) vision, but farther away than reading (near) vision.

Most young people wear eyeglasses to correct their distance vision. Reading glasses are prescribed to correct near vision only. And bifocals prescribed for those over age 40 with presbyopia correct only near and far. None of these eyeglasses are optimized for the intermediate zone of vision used during computer work.

Even trifocals and progressive lenses, which do include the correct power for intermediate vision, have only a small portion of the lens dedicated to this area — not nearly a large enough area for comfortable prolonged computer work.

Without the appropriate eyewear, computer users can often end up with blurred vision, eyestrain, and headaches — the hallmark symptoms of computer vision syndrome (CVS). Worse still, many people try to compensate for their blurred vision by leaning forward, or by tipping their head to look through the bottom portion of their glasses. These unnatural postures can lead to headaches, neck and shoulder pain, and backaches.

Computer glasses reduce errors and increase productivity

Are computer glasses worth the extra cost of a second pair of glasses?

Yes, they are. Research has shown that, in addition to increasing comfort and decreasing the risk of CVS, prescription computer glasses can reduce errors and losses of productivity caused by vision problems during computer work.

A study conducted at the University of Alabama School of Optometry found that even minor changes from the optimum lens power for computer work can cause a 38% decrease in accuracy for tasks performed on a computer and a 9% loss in worker productivity.

The researchers concluded that, because of productivity gains from workers wearing computer glasses, companies that pay for computer eyewear for their employees could experience a benefit/cost ratio of $18 for every $1 spent.

Computer lens designs

There are a number of special purpose lens designs that work well for computer glasses. Because these lenses are prescribed specifically for computer use, they are unsuitable for driving or general purpose wear.

The simplest computer glasses have single vision lenses with a modified lens power prescribed to give the most comfortable vision at the user's computer screen. These lenses relax the amount of focusing the eyes have to do to keep images on the computer screen clear and provide the largest field of view, reducing the need for head tilting and other unnatural posture changes during computer work.

For older computer users, a specially designed progressive lens for computer use is sometimes a better option. Progressive lenses for computer use have a larger intermediate zone than regular progressive lenses for a wider, more comfortable view of the computer screen.

Another option for presbyopic computer users is a lined trifocal, with a larger intermediate zone than regular trifocals. Still another possibility is an occupational bifocal, with the top part of the lens for intermediate vision (computer screen) and the bottom portion for near vision (reading).

Your eyecare professional can help you decide which lens design will best suit your needs.

Lens coatings and treatments

Anti-reflective (AR) coating can make your computer glasses even more comfortable. This coating reduces glare caused by reflections of overhead fluorescent lighting that can occur in uncoated eyeglass lenses.

Also, because many office environments are too bright for optimum visual comfort, a light tint is often a good idea as well. Special tints are available that selectively block different wavelengths of indoor lighting for greater comfort.

For more information on presbyopia and lens coatings, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Computer Vision Syndrome Q & A

What can I do when my eyes tire out from too much reading and computer use?

This is a common problem. See your eye doctor about computer eyeglasses that will help you focus more accurately and with less effort. When prescribed properly, these glasses can also help you read printed material. Lenses also can have tints and coatings to make your eyes feel a lot better.

Also, take frequent breaks (every 15-20 minutes) from reading or computer use. Look at something far away, like an object outside a window, to relax your focusing muscles. And make sure the lighting is correct for the activity you are doing — bright for reading and a bit dimmer for computer work.

Is it necessary to wear special eye protection when working on the computer? Is such protection necessary if I already wear prescription eyeglasses?

Computer screens don't emit enough radiation to cause eye damage, so protective eyewear isn't necessary. Eyestrain is another issue, however. Having an accurate, up-to-date prescription and an ergonomically appropriate workstation can make a huge difference in managing your visual comfort while using your computer. Also, consider adding an anti-reflective coating on your lenses to minimize glare.

My eyes become sensitive to light when I do a lot of reading on a computer screen. Sometimes, the words will appear to change size. Also, my distance vision sometimes is blurred after I do computer work. Is this computer vision syndrome, and what should I do about it?

Yes, all these symptoms suggest you have computer vision syndrome (CVS). Focusing problems are common among people who spend a lot of time at a computer. An eyecare professional who understands this phenomenon can prescribe eyeglasses that will help you be more comfortable and should relieve your symptoms. You can also help yourself by making sure your work station is efficient and comfortable. Check out the lighting, height of your screen, angle of your screen, hand position, etc.

Can your eyes and face get burned by computer monitors?

No. If they could, you'd see a lot of red-faced and red-eyed people.

My eyes often become red when I read a book or use a computer. Will eye drops help?

Your eyes becoming red could be a sign that you are having trouble focusing. Have your eyes examined to see if you should wear glasses to alleviate near vision stress. See an eye doctor before using over-the-counter eye drops on a regular basis. Your doctor will be able to determine if you need drops and, if so, which type of eye drops will be best for you.

How can I relieve eye stress from working at a computer all day?

To relieve eyestrain from prolonged computer use, take frequent breaks during your work day. About every 15 minutes, look up and far away, preferably out a window or across the room. Also, make sure your work station is correctly structured and lighted. Your screen or monitor should be positioned about 20 to 26 inches from your eyes, slightly below eye level. Tilt the screen slightly away from you at the top, the way you would hold a book, to reduce glare from reflected light. Adjust the screen contrast to be comfortable, and the room lighting shouldn't be too bright.

Also, see your eye doctor for regular exams to monitor your vision. Even a slight vision change can cause eyestrain during computer work. Special computer glasses can help you see your screen with less focusing effort, and your eye doctor can advise you about lens coatings and tints that can also help relieve eyestrain.

Please note: This information is designed to provide helpful information about vision, vision care and vision correction. It is not intended as a substitute for medical advice. If you suspect that you have a vision problem or a condition that requires medical attention, see an eye care professional immediately.

For more information on computer vision, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

FAQ: Computer Vision Syndrome and Computer Glasses

Who is affected by Computer Vision Syndrome?

Estimates vary, but some experts say 50% to 90% of computer users experience eyestrain or other symptoms of computer vision syndrome (CVS). Though CVS is often associated with adult computer users, children may be even more vulnerable to the condition.

What are the symptoms of CVS?

Symptoms of computer vision syndrome include:

        Headaches

        Loss of focus

        Burning/tired eyes

        Double/blurred vision

        Dry eyes

        Neck and shoulder pain

What causes Computer Vision Syndrome?

CVS is caused by the increased demands of computer-generated images on our eyes and visual systems and by the prolonged and/or repetitive nature of computer work.

Our eyes have little problem focusing on most printed material, which is characterized by dense black characters with well-defined edges. Characters on a computer screen, however, don't have the same high contrast or well-defined borders. The luminous elements (pixels) that create images on a computer screen are brightest at the center and diminish in intensity toward their edges. This makes it more difficult for our eyes to accurately focus on computer-generated images compared to images printed with ink in a book or magazine.

As our eyes struggle to gain and maintain focus on images on a computer screen, this continuous flexing of the eyes' focusing muscles creates fatigue and the burning, tired-eyes feeling that is so common after long hours at the computer.

In addition, it's common for computer users to fall into bad postural habits and remain in these positions for extended periods of time, causing muscle strain, fatigue and headaches.

What can I do about CVS?

A pair of computer eyeglasses can help relieve many of the symptoms of CVS. Unlike regular eyeglasses, computer glasses are prescribed specifically for the distance from your eyes to your computer screen. This reduces the focusing demands on your eyes during computer use to lessen eye fatigue and reduce the risk for eyestrain and other computer-related vision problems.

Will glare screens prevent CVS?

A glare filter for your computer screen may help somewhat, but it will not solve all your computer vision problems. Filters can reduce glare from overhead lights or outdoor sunlight reflecting off the surface of your computer screen. But they do nothing to prevent the vision problems related to the constant refocusing of your eyes when working at a computer.

Only when your eyes can focus clearly at the plane of proper distance on the computer screen can they experience relief from the fatiguing effects of CVS. An anti-reflective coating (AR) is also highly recommended on all computer eyeglasses.

Will anti-reflective coating on my eyeglasses eliminate glare?

Anti-reflective (AR) coatings reduce glare from light reflecting off the front and back surfaces of your eyeglass lenses. So. like filters for your computer screen, AR coatings for eyeglass lenses are helpful, but they do not address the primary cause of most CVS symptoms.

Will computer eyeglasses make the screen clearer?

Yes, because they will eliminate the constant refocusing effort that your eyes go through when viewing the screen. Research has also shown that wearing computer eyeglasses increases productivity and accuracy.

Do computer glasses look like safety glasses?

No. Almost any style of frame can be used for computer glasses. Also, the lenses of computer glasses don't have to pass the stringent impact-resistance standards required of lenses in safety glasses.

Should computer lenses be tinted?

If you work in a very bright office, you may benefit from a light tint applied to your computer lenses. This can cut the amount of light that reaches your eyes and provide relief in some cases. But tints and filters don't address the underlying cause of computer eyestrain.

If I don't have symptoms of CVS, do I still need computer eyewear?

Maybe. Research has shown that even computer users who are not experiencing symptoms of CVS may benefit from wearing computer eyewear. An eye exam with a computer vision specialist is the best way to determine if computer glasses might be helpful for you.

Will insurance pay for these glasses?

In some cases, yes. If you have medical coverage, but not vision insurance, the exam portion of the cost may be covered by your medical carrier. If you have vision insurance, you may be entitled to an annual exam, which could be used to cover the computer exam and a portion of the cost of the computer eyewear.

Will my reading glasses work at the computer?

Not necessarily. As with anything else you do in life, it's important to have the right tool for the job. You would not use a hammer when you need a screwdriver. The same goes for your vision. You would not use distance glasses for doing close work. So, in most cases, your reading glasses are probably not going to do the job at the computer. Reading glasses are usually prescribed to optimize vision at a distance of approximately 14 to 16 inches from your eyes. Computer glasses are designed to provide optimum vision at a normal computer distance — usually 20 to 28 inches from your eyes.

Isn't ergonomics the solution to computer eyestrain?

Ergonomics can be defined as the science of designing and arranging things people use to enable interaction in the most efficient and safe manner possible. Taking these steps can be an important component of preventing and treating CVS. But ergonomics alone--placing a computer screen at a comfortable height and distance from the user, for example--cannot fix a vision problem. This can only be achieved with prescription eyewear.

Will wearing computer eyeglasses make my eyes worse?

No. There is no evidence that wearing computer glasses harms your eyes or causes changes such as myopia (nearsightedness), farsightedness or astigmatism. In fact, some research suggests that reducing focusing stress with special lenses for reading or computer use may slow the progression of myopia in some school-aged children.

For more information on relief of eye strain, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Worker Productivity and Computer Vision Syndrome

If you use a computer at work, you probably already know that a long day of staring at your screen can lead to eyestrain, tired eyes, headache, muscle aches and other symptoms of computer vision syndrome (CVS).

But did you know that CVS can also cause more mistakes and lost productivity, too?

CVS increases vision problems in the workplace

According to the American Optometric Association (AOA), the most frequent health complaints among computer workers are vision-related. Studies suggest 50% to 90% of computer users suffer from visual symptoms of computer vision syndrome. These symptoms include eyestrain, dry eyes or eye irritation, blurred vision and double vision.

With increasing numbers of employees using a computer at work, CVS is becoming a major public health issue. The AOA reports that approximately 10 million eye exams are performed annually in the U.S. due to vision problems related to computer use.

Worker productivity and CVS

A recent study conducted by the University of Alabama at Birmingham (UAB) School of Optometry examined the relationship between the vision of computer workers and their productivity in the workplace. The study found:

  • There is a direct correlation between proper vision correction and productivity. This relationship particularly is evident with complex and/or repetitive computer tasks such as data entry.
  • There is a direct correlation between proper vision correction and the time required for a computer worker to perform a task. Computer-related tasks took much longer when the subjects wore glasses with less than the optimum correction for computer work.
  • Reduced productivity from vision problems can occur even if the computer user is unaware they have a vision problem. Performance on a specific task can suffer significantly — by as much as 20% — from minor vision problems.

"Our data strongly suggest that improving the visual status of workers using computers results in greater productivity in the workplace, as well as improved visual comfort," said Kent Daum, OD, PhD, the study's chief investigator.

Computer eyewear and the bottom line

According to the UAB study, employers who invest in computer eyewear for their employees can experience a positive impact on their bottom line from such a program.

The authors of the study concluded:

  • Providing computer vision care to all employees who use computers, even those who are not experiencing CVS symptoms, results in significant productivity gains and cost savings for employers.
  • Musculoskeletal problems, which may be caused by computer-related vision problems, can potentially be minimized or eliminated by including computer vision care in a comprehensive ergonomics program.
  • Employees performing tasks with particularly demanding visual requirements, such as accounting, document editing, CAD (computer-assisted design) work, electronic design and engineering, could benefit even more from computer eyewear than the average computer worker.
  • A computer vision benefits program likely will also lower incidence of workers' compensation claims among computer workers.

"Our study confirms that investing in optimal computer eyewear for employees results in a significant cost-benefit ratio," Dr. Daum said.

For more information on computer vision, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Contact Lenses

Bifocal and Multifocal Contact Lenses

Bifocal and multifocal contact lenses are designed to give you good vision when you reach your 40s. Beginning at this age, you may need to hold reading material – like a menu or newspaper – farther from your eyes to see it clearly. This condition is called "presbyopia."

Bifocal and multifocal contact lenses are available in both soft and rigid gas permeable (GP) materials.

Bifocals, multifocals – What's the difference?

Bifocal contacts lenses (like bifocal eyeglass lenses) have two powers – one for seeing clearly far away and one for seeing clearly up close. Multifocal contact lenses, like progressive eyeglass lenses, have a range of powers for seeing clearly far away, up close and everywhere in between. ("Multifocal" is also a catch-all term for all lenses with more than one power, including bifocals.)

Types of multifocal contact lenses

Based on design, there are basically two types of multifocal contact lenses:

  1. Simultaneous vision lenses. With these lenses, both distance and near zones of the lens are in front of your pupil at the same time. Although this might sound unworkable, after a short period of time your visual system learns to use the power you need and ignore the other lens power(s), depending on what you are looking at. Simultaneous vision lenses are the most popular type of multifocal contact lens. They are nearly always soft lenses, and are available in two designs:
  2. Concentric ring designs – These are bifocal lenses with either the distance or near power in the center of the lens, with alternating rings of distance and near powers surrounding it.  

    Aspheric designs – These are progressive-style multifocal lenses, with many powers blended across the lens surface. Some aspheric lenses have the distance power in the center of the lens; others have the near power in the center.

  3. Alternating vision (or translating) lenses. These are GP multifocal lenses that are designed like bifocal eyeglass lenses. The top part of the lens has the distance power, and the bottom part of the lens contains the near power. When you look straight ahead, your eye is looking through the distance part of the lens. When you look down, your lower lid holds the lens in place while your pupil moves (translates) into the near zone of the lens for reading.   

Will multifocal contact lenses work for me?

Most people who try multifocal contact lenses are happy with them. But some compromises may be necessary when you wear these lenses. For example, your distance vision with multifocal contact lenses may not seem clear enough, or you may have troubles with glare at night or not being able to see small print.

In some cases, a better solution for presbyopia may be a monovision or modified monovision fitting of regular ("single vision") contact lenses.

In monovision, you wear a single vision contact lens on one eye for your distance vision and a single vision contact lens on the other eye that has a prescription for your near vision. In modified monovision, you wear a single vision "distance lens" on one eye and a multifocal contact lens on the other eye to help you see better up close.

To determine the best contact lenses for your vision needs when you reach "bifocal age," call our office for a consultation.

For more information on bifocal and multifocal contact lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Contacts Lenses for the "Hard-to-Fit" Patient

Not everyone is an ideal candidate for contact lenses. If you have one or more of the following conditions, contact lens wear may be more difficult:

  • astigmatism
  • dry eyes
  • presbyopia
  • giant papillary conjunctivitis (GPC)
  • keratoconus
  • post-refractive surgery (such as LASIK)

But "difficult" doesn't mean impossible. Often, people with these conditions can wear contacts quite successfully. Let's take a closer look at each situation – and possible contact lens solutions.

Contact lenses for astigmatism

Astigmatism is a very common condition where the curvature of the front of the eye isn't round, but is instead shaped more like a football or an egg. This means one curve is steeper or flatter than the curve 90 degrees away. Astigmatism won't keep you from wearing contact lenses – it just means you need a different kind of lens.

Lenses specially designed to correct astigmatism are called "toric" lenses. Most toric lenses are soft lenses. Toric soft lenses have different corrective powers in different lens meridians, and design elements to keep the lens from rotating on the eye (so the varying corrective powers are aligned properly in front of the different meridians of the cornea).

In some cases, toric soft lenses may rotate too much on the eye, causing blur. If this happens, different brands that have different anti-rotation designs can be tried. If soft lens rotation continues to be a problem, gas permeable (GP) lenses (with or without a toric design) can also correct astigmatism.

Contact lenses for dry eyes

Dry eyes can make contact lens wear difficult and cause a number of symptoms, including:

  • a gritty, dry feeling
  • feeling as if something is in your eye
  • a burning sensation
  • eye redness (especially later in the day)
  • blurred vision

If you have dry eyes, the first step is to treat the condition. This can be done a number of ways, including artificial tears, medicated eye drops, nutritional supplements, and a doctor-performed procedure called punctal occlusion to close ducts in your eyelids that drain tears away from your eyes.

Once the dry eye condition is treated and symptoms are reduced or eliminated, contact lenses can be tried. Certain soft contact lens materials work better than others for dry eyes. Also, GP lenses are sometimes better than soft lenses if there's a concern about dry eyes since these lenses don't dry out the way soft lenses can.

Replacing your contacts more frequently and reducing your wearing time each day (or removing them for specific tasks, such as computer work) can also reduce dry eye symptoms when wearing contacts.

Contact lenses for giant papillary conjunctivitis (GPC)

Giant papillary conjunctivitis (GPC) is an inflammatory reaction on the inner surface of the eyelids. One cause of GPC is protein deposits on soft contact lenses. (These deposits are from components of your tear film that stick to your lenses and become chemically altered.)

Usually, changing to a one-day disposable soft lens will solve this problem, since you just throw these lenses away at the end of the day before protein deposits can accumulate on them. Gas permeable lenses are also often a good solution, as protein deposits don't adhere as easily to GP lenses, and lens deposits on GP lenses are more easily removed with daily cleaning.

In some cases of GPC, a medicated eye drop may be required to reduce the inflammation before you can resume wearing contact lenses.

Contact lenses for presbyopia

Presbyopia is the normal loss of focusing ability up close when you reach your 40s.

Today, there are many designs of bifocal and multifocal contact lenses to correct presbyopia. Another option for presbyopia is monovision. This is wearing a contact lens in one eye for distance vision and a lens in the other eye that has a modified power for near vision.

During your contact lens fitting we can help you decide whether bifocal/multifocal contact lenses or monovision is best for you.

Contact lenses for keratoconus

Keratoconus is a relatively uncommon eye condition where the cornea becomes thinner and bulges forward. The term "keratoconus" comes from the Greek terms for cornea ("kerato") and cone-shaped ("conus"). The exact cause of keratoconus remains unknown, but it appears that oxidative damage from free radicals plays a role.

Gas permeable contact lenses are the treatment option of choice for mild and moderate keratoconus. Because they are rigid, GP lenses can help contain the shape of the cornea to prevent further bulging of the cornea. They also can correct vision problems caused by keratoconus that cannot be corrected with eyeglasses or soft contacts.

In some cases, a soft contact lens is worn under the GP lens for greater comfort. This technique is called "piggybacking." Another option for some patients is a hybrid contact lens that has a GP center, surrounded by a soft "skirt".

Contact lenses after corrective eye surgery

More than one million Americans each year have LASIK surgery to correct their eyesight. Sometimes, vision problems remain after surgery that can't be corrected with eyeglasses or a second surgical procedure. In these cases, gas permeable contact lenses can often restore visual acuity and eliminate problems like glare and halos at night.

GP lenses are also used to correct vision problems after corneal transplant surgery, including irregular astigmatism that cannot be corrected with eyeglasses.

GP lenses prescribed after LASIK and corneal transplants sometimes have a special design called a "reverse geometry" design to better conform to the altered shape of the cornea. The back surface of these lenses is flatter in the center and steeper in the periphery. (This is the opposite of a normal GP lens design, which is steeper in the center and flattens in the periphery.)

Problem-solving contact lens fittings cost more

Fitting contact lenses to correct or treat any of the above conditions will generally take much more time than a regular contact lens fitting. These "hard-to-fit" cases usually require a series of office visits and multiple pairs of trial lenses before the final contact lens prescription can be determined. Also, the lenses required for these conditions are usually more costly than regular soft contact lenses. Therefore, fees for these fittings are higher than fees for regular contact lens fittings. Call our office for details.

Find out if you can wear contact lenses

If you are interested in wearing contact lenses, call our office to schedule a consultation. Even if you've been told you're not a good candidate for contacts because you have one of the above conditions or for some other reason, we may be able to help you wear contact lenses safely and successfully.

For more information on contact lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Cornea Transplant

A cornea transplant, which replaces damaged tissue on the eye's clear surface, also is referred to as a corneal transplant, keratoplasty, penetrating keratoplasty (PK) or corneal graft.

A cornea transplant replaces central corneal tissue, damaged due to disease or injury, with healthy corneal tissue donated from an eye bank. An unhealthy cornea affects your vision by scattering light and causing blurred or distorted vision. In some cases, a cornea can be so damaged or scarred that a transplant is necessary to restore your functional vision.

Cornea transplants are performed routinely. In fact, of all tissue transplants, the most successful is a corneal transplant. The National Keratoconus Foundation estimates that more than 40,000 cornea transplants are performed in the United States each year.

A new version of corneal transplant, known as Descemet's Stripping Endothelial Keratoplasty (DSEK), also has been introduced as a new surgical method that uses only a very thin portion of the cornea for transplant. In certain cases, this type of procedure may be preferred because it has advantages such as being less likely to create an irregular corneal surface (astigmatism) as a side effect.

Are you a candidate for a cornea transplant?

Your eye doctor may suggest a corneal transplant for reasons varying from diseases to eye injuries, which can include the following:

  • Scarring from infections, such as eye herpes or fungal keratitis.
  • Eye diseases such as keratoconus.
  • Hereditary factors or corneal failure from previous surgeries.
  • Thinning of the cornea and irregular shape (such as with keratoconus).
  • Complications from LASIK.
  • Chemical burns on the cornea or damage from an eye injury.
  • Excessive swelling (edema) on the cornea.

The cornea transplant procedure

Once you and your doctor have decided that a corneal transplant is the best option to restore your functional vision, your name is placed on a list at a local eye bank. The waiting period for a donor eye is generally one to two weeks due to a very sophisticated eye bank system in the U.S. Before donor corneas are released for transplant, tissue is checked for clarity. Also, donor eyes supplying transplant tissue are meticulously screened for presence of diseases such as hepatitis and AIDS or other damage to ensure the health and safety of the recipient.

Typically, corneal transplants are performed on an outpatient basis, meaning that you will not need hospitalization. Local or general anesthesia is used, depending on your health, age, and whether or not you prefer to be asleep during the procedure. With local anesthesia, an injection into the skin around your eye is used to relax muscles that control blinking and movement, and eye drops are used to numb the eye itself.

After the anesthesia has taken effect, the eyelids are held open while your eye surgeon inspects and measures the affected corneal area in order to determine the size of the transplantation. A round, button-shaped section of tissue is then removed from your diseased or injured cornea. A nearly identical-shaped button from the donor tissue is then sutured into place. Finally, the surgeon will place a plastic shield over your eye to protect it from being inadvertently rubbed or bumped. The surgery takes one to two hours.

Cornea graft rejection

Most corneal transplants are successful. The best way to prevent corneal transplant rejection is to recognize the warning signs:

  • Redness
  • Extreme sensitivity to light
  • Decreased vision
  • Pain

Rejection signs may occur as early as one month or as late as five years after surgery. If you have complications with your corneal transplant, your doctor will prescribe medication that can reverse the rejection process. Should your graft fail, the corneal transplant can be repeated, generally with good results. Still, overall rejection rates increase with the number of corneal transplants you have.

Recovering from a cornea transplant

The total recovery time for a corneal transplant may be up to a year or longer. Initially, your vision will be blurry and the site of your corneal transplant may be swollen and slightly thicker than the rest of your cornea. As your vision is restored, you will gradually be able to return to your normal daily activities.

For the first several weeks, heavy exercise and lifting are prohibited. However, you should be able to return to work three to seven days after surgery, depending on your job. Steroid eye drops will be prescribed for several months to help your body accept the new corneal graft. You should keep your eye protected at all times by wearing a shield or a pair of eyeglasses so that nothing inadvertently bumps or enters your eye.

Stitches may be removed from three months to more than a year after surgery, depending on the health of your eye and the rate of healing. Adjustments may be made to the sutures surrounding the new cornea to help reduce the amount of astigmatism resulting from an irregular eye surface.

Your eyesight after a cornea transplant

Your vision will continue to improve up to one year following your surgery. But you will need glasses or contact lenses after surgery, because the curve of the corneal transplant cannot match exactly the curve of your natural cornea. After healing is complete and stitches are removed, it is possible to undergo laser vision correction (LASIK or PRK) to improve your vision and decrease your dependence on glasses or contact lenses.

Rigid gas permeable (RGP or GP) contact lenses often provide the best vision correction for corneal transplant patients due to the irregularity of the cornea after transplant.

Regardless of whether you need corrective eyewear, it's wise to wear safety glasses after a cornea transplant to protect your eyes from injury.

For more information on eye conditions and diseases, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Eye Exams for Contact Lenses

For many people, contact lenses provide greater convenience and more satisfying vision correction than eyeglasses. Here's what's involved in a typical contact lens exam and fitting:

A comprehensive eye exam comes first

Before being fit with contact lenses, a comprehensive eye exam is performed. In this exam, your eye doctor determines your prescription for corrective lenses (just a glasses prescription at this point) and checks for any eye health problems or other issues that may interfere with successful contact lens wear.

If all looks good during your eye exam, the next step is a contact lens consultation and fitting.

What to expect during a contact lens fitting

The first step in a contact lens fitting is a consideration of your lifestyle and your preferences regarding contact lenses, such as whether you might want to change your eye color with color contact lenses or if you're interested in options such as daily disposables or overnight wear. Although most people choose soft contact lenses, the advantages and disadvantages of rigid gas permeable (GP) lenses will likely be discussed as well.

If you are over age 40 and need bifocals, your eye doctor or contact lens specialist will discuss ways to deal with this need, including multifocal contact lenses and monovision (a prescribing technique where one contact lens corrects your distance vision and the other lens corrects your near vision).

Contact lens measurements

Just as one shoe size doesn't fit all feet, one contact lens size doesn't fit all eyes. If the curvature of a contact lens is too flat or too steep for your eye's shape, you may experience discomfort or even damage to your eye. Measurements that will be taken to determine the best contact lens size and design for your eyes include:

  • Corneal curvature: An instrument called a keratometer is used to measure the curvature of your eye's clear front surface (cornea). This measurement helps your doctor select the best curve and diameter for your contact lenses.
      
    If your eye's surface is found to be somewhat irregular because of astigmatism, you may require a special lens design of lens known as a "toric" contact lens. At one time, only gas permeable contact lenses could correct for astigmatism. But there are now many brands of soft toric lenses, which are available in disposable, multifocal, extended wear and colored versions.

In some cases, a detailed mapping of the surface of your cornea (called corneal topography) may be done. Corneal topography provides extremely precise details about surface characteristics of the cornea and creates a surface "map" of your eye, with different contours represented by varying colors. 

  • Pupil and iris size: The size of your pupil and iris (the colored part of your eye) can play an important role in determining the best contact lens design, especially if you are interested in GP contact lenses. These measurements may be taken with a lighted instrument called a biomicroscope (also called a slit lamp) or simply with a hand-held ruler or template card.
  • Tear film evaluation: To be successful wearing contact lenses, you must have an adequate tear film to keep the lenses and your cornea sufficiently moist and hydrated. This test may be performed with a liquid dye placed on your eye so your tears can be seen with a slit lamp, or with a small paper strip placed under your lower lid to see how well your tears moisten the paper. If you have dry eyes, contact lenses may not be right for you. Also, the amount of tears you produce may determine which contact lens material will work best for you. 

Trial lenses

In many cases, trial lenses will be used to verify the contact lens selection. Lenses will be placed on your eye and your doctor will use the slit lamp to evaluate the position and movement of the lenses as you blink and look in different directions. You will also be asked how the lenses feel.
 
You'll typically need to wear these trial lenses at least 15 minutes so that any initial excess tearing of the eye stops and your tear film stabilizes. If all looks good, you will be given instructions on how to care for your lenses and how long to wear them. You will also receive training on how to handle, apply and remove the lenses.

Follow-up visits confirm the fit and safety 

Your contact lens fitting will involve a number of follow-up visits so your doctor can confirm the lenses are fitting your eyes properly and that your eyes are able to tolerate contact lens wear. A dye (like the one used to evaluate your tear film) may be used to see if the lenses are causing damage to your cornea or making your eyes become too dry.

Often, your doctor will be able to see warning signs before you are aware a problem with your contact lens wear is developing. If such warning signs are evident in your follow-up visits, a number of things may be recommended, including trying a different lens or lens material, using a different lens care method, or adjusting your contact lens wearing time. In occasional cases, it may be necessary to discontinue contact lens wear altogether.

Your contact lens prescription  

After finding a contact lens that fits properly, is comfortable for you, and provides good vision, your doctor will then be able to write a contact lens prescription for you. This prescription will designate the contact lens power, the curvature of the lens (called the base curve), the lens diameter, and the lens name and manufacturer. In the case of GP contact lenses, additional specifications may also be included.

Routine contact lens exams

Regardless of how often or how long you wear your contact lenses, your eyes should be examined at least once a year to make sure your eyes are continuing to tolerate contact lens wear and show no signs of ill effects from the lenses.

For more information on contact lenses or eye exams, visit All About Vision>®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Gas Permeable (GP) Contact Lenses

Gas permeable (GP) contact lenses, also known as rigid gas permeable (RGP) lenses, are hard contact lenses made of silicone-containing compounds that allow oxygen to pass through the lens material to the eye. Though not as popular as soft contact lenses, GP lenses offer a number of advantages over soft lenses.

Advantages of gas permeable lenses

  1. GP lenses allow your eyes to "breathe" better. GP lenses allow more oxygen to reach the front surface of the eye. This reduces the risk of eye problems caused by hypoxia (reduced oxygen supply). Gas permeable lenses provide a better oxygen supply than most soft lenses because:
  2. The silicone-containing lens materials of GP lenses are more permeable to oxygen than many soft lens materials (though new " silicone hydrogel" soft lenses are comparable to GPs in oxygen transmission).

    GP lenses are smaller in diameter than soft lenses, so they cover up less of the front surface of the eye (the cornea).

    Gas permeable lenses hold their shape and move on the eye with each blink. This movement pumps oxygen-containing tears under the lens. Soft lenses conform to the shape of the cornea and have only minimal movement with blinks, so little or no tears circulate under soft lenses.

  3. GP lenses provide sharper vision. Because they are custom-machined to a smooth surface and maintain their shape on the eye, GP lenses provide sharper vision than soft lenses, which can fluctuate in shape and clarity if they start to dry out. Gas permeable lenses also provide a more stable and accurate correction of astigmatism.
  4. GP lenses last longer. GP lenses are rigid, so there's no worry about ripping or tearing them. They are also easier to keep clean and don't need to be replaced frequently like soft lenses. With proper care, a single pair of GP lenses can last a year or longer. And since they're long-lasting, GP can be less expensive than soft lenses in the long run.
  5. GP lenses may slow the progression of nearsightedness. In addition to their other advantages, some research suggests that wearing gas permeable lenses may slow the progression of myopia (nearsightedness) in some children. GPs are also used for orthokeratology, where specially designed contacts are worn during sleep to reshape the cornea and improve vision.

The Downside of GP Contact Lenses

So why doesn't everyone wear GP lenses? Potential disadvantages of GP lenses (compared to soft lenses) include:

1.  Need for adaptation. Unlike wearing soft lenses (which are comfortable right from the start), you may need few weeks before you can wear GP lenses comfortably all day. Initially, you may be able to wear the lenses only a few hours daily until your corneas adapt to them. But if you can tough it out for those first few days, you may be pleasantly surprised at how comfortable GP lenses become. Many people who switch from soft lenses to gas permeable lenses say GP lenses are more comfortable than soft lenses (after their eyes fully adapt) and their vision is noticeably clearer.

2.  Inability to wear part-time. To fully adapt to GP lenses and to stay comfortable wearing them, you have to wear them every day. If you stop wearing them for several days, you will be more aware of the lenses on your eyes and you'll have to re-adapt to the lenses.

3.  Increased possibility of dislodging. Because they are smaller than soft lenses, gas permeable lenses can dislodge from your eyes during contact sports or if you rub your eyes aggressively.

4.  Vulnerability to sand and dust. GP lenses don't conform to the shape of your eye like soft lenses do, so it's possible sand or dust can get under your lenses at the beach or on a windy day. (You can minimize this risk by wearing wrap-style sunglasses outdoors.)

5.  Higher lens replacement costs. Unlike soft lenses, which come in limited sizes, GP lenses are custom-made to the shape of your eye. This makes GP lenses more expensive to replace if you lose them. Also, it can take up to a week to get a GP lens replaced.So it's a good idea to purchase a spare pair to avoid the inconvenience of being without your GP lenses if you lose or break one.

Best of Both Worlds?

Since comfort is the primary barrier to GP use, an interesting innovation is the hybrid contact lens. These lenses have a GP center, surrounded by a soft lens "skirt." The goal of hybrid lenses is to provide the clarity of a gas permeable lens and wearing comfort that rivals that of a soft lens.

Call for more information and a trial fitting

To see if gas permeable lenses are right for you, call our office for more information and to schedule a trail fitting.

For more information on GP contact lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Orthokeratology: Reshaping the Eye with Contact Lenses

Orthokeratology, or "ortho-k," is the process of reshaping the eye with specially-designed rigid gas permeable (GP) contact lenses. The goal of ortho-k is to flatten the front surface of the eye and thereby correct mild to moderate amounts of nearsightedness and astigmatism.

How ortho-k works

The GP lenses for ortho-k are applied at bedtime and worn overnight. While you sleep, the lenses gently reshape the front surface of your eye (the cornea) to correct your vision, so you can see clearly without glasses or contact lenses when you're awake. The effect is temporary – generally enough to get you through a day or two – so you must wear the reshaping lenses each night to maintain good vision during the day.

Currently, there are two brands of orthokeratology approved by the FDA:  Corneal Refractive Therapy (CRT) from Paragon Vision Sciences and Vision Shaping Treatment (VST) from Bausch & Lomb.

Who is a candidate for ortho-k?

Orthokeratology is frequently a good option for nearsighted individuals who are too young for LASIK surgery or for some other reason are not good candidates for vision correction surgery. Because it can be discontinued at any time without permanent change to the eye, people of any age can try the procedure, as long as their eyes are healthy.

Ortho-k is particularly appealing for people who participate in sports, or who work in dusty, dirty environments that can make contact lens wear difficult.

What results can you expect from ortho-k?

The goal for ortho-k is to correct your vision to 20/20 without eyeglasses or contact lenses during the day. In FDA trials of both CRT and VST lenses, more than 65% of patients were able to achieve 20/20 visual acuity after wearing the reshaping lenses overnight. More than 90% were able to see 20/40 or better (the legal vision requirement for driving without glasses in most states).

Success rates for ortho-k tend to be higher for mild prescriptions. Call our office to find out if your prescription is within the range that can be successfully treated with ortho-k.

How long does ortho-k take?

Though you may see some improvement in your vision after a day or two of overnight ortho-k, it can take several weeks for the full effect to be apparent. During this time, your vision will not be as clear as it was with glasses or contacts, and you are likely to notice some glare and halos around lights. It's possible you may need a temporary pair of eyeglasses for certain tasks, like driving at night, until your vision is fully corrected by the ortho-k lenses.

Is ortho-k comfortable?

Some people have comfort issues when attempting to wear gas permeable contact lenses during the day. But since ortho-k GP lenses are worn during sleep, comfort and lens awareness are generally not a problem.

Cost of orthokeratology

Ortho-k is a significantly longer process than a regular contact lens fitting. It requires a series of office visits and potentially multiple pairs of lenses. Also, GP lenses used for ortho-k are more costly than most regular contact lenses. Therefore, fees for orthokeratology are higher than fees for regular contact lens fittings.

Can I have LASIK after ortho-k?

Yes, it's possible to have LASIK surgery after orthokeratology. But because ortho-k lenses reshape your cornea, you must stop wearing the lenses for a period of time (usually several months) so your eyes can return to their original shape and stabilize. Be sure to tell your LASIK surgeon that you've worn ortho-k lenses, so they can advise you how long you should wait before having the surgery.

For more information on orthokeratology, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Toric Contact Lenses for Astigmatism

If you have astigmatism – a common condition where the eye isn't perfectly round, but more football- or egg-shaped – then you'll need a special design of contact lenses called "toric" lenses for clear vision.

Toric contact lenses are available in both soft and rigid gas permeable (RGP or GP) lens materials. Most contact lens wearers who need toric contacts choose soft toric lenses.

How do toric lenses work?

When you have astigmatism, different meridians of your eye need different amounts of correction for nearsightedness or farsightedness. Imagine the front of your eye is like the face of a clock: A line drawn from the 12 to the 6 is one meridian, a line from the 1 to the 7 is another, and so on.

Soft toric contact lenses have different powers in different meridians of the lens to correct the eye's astigmatism. They also have design elements to keep the lens from rotating on your eye, so the meridians of the lens stay aligned with the meridians of your eye.

Today, you can choose from many brands and styles of soft toric lenses.  So if Brand A doesn't fit properly or rotates too much, Brand B may perform better. And if soft toric lenses don't adequately correct your astigmatism, gas permeable lenses will often do the trick.

Toric contact lens cost

Properly fitting a toric contact lens takes more time and requires more expertise than fitting regular soft contacts. Several office visits are required, and sometimes several different lenses must be evaluated. Consequently, our professional fee for fitting toric lenses is higher than our fee for a regular contact lens fitting. The lenses themselves also cost more than regular soft lenses. Call our office for details.

Gas permeable lenses for astigmatism

If you have a mild to moderate amount of astigmatism, you may want to consider gas permeable contact lenses. GP lenses usually provide sharper vision than soft toric lenses. And because gas permeable lenses are rigid and maintain their shape on the eye, a toric GP design usually isn't needed. The astigmatism due to unequal curves on the front surface of your eye is corrected by a layer of tears that forms between your eye and the spherical back surface of the GP lens.

If regular gas permeable lenses fail to adequately correct the astigmatism, customized toric GP lens designs are also available.

Many options in soft toric lenses

Today, many brands of soft toric lenses are available and you have a choice of lenses approved for daily wear (lenses you remove before sleep) and extended wear (lenses approved for overnight wear). There are also soft toric lenses to enhance or change your eye color and multifocal toric lenses if you have presbyopia.

Call for more information

Call our office today to learn more about contact lens options for astigmatism and to schedule a contact lens consultation to find out which lenses are the best solution for you.

For more information on toric contacts, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Eye Exams

Eye Exams for Children

As a parent, you may wonder whether your pre-schooler has a vision problem or when a first eye exam should be scheduled.

Eye exams for children are extremely important. Experts say 5 percent-10 percent of pre-schoolers and 25 percent of school-aged children have vision problems. Early identification of a child's vision problem is crucial because, if left untreated, some childhood vision problems can cause permanent vision loss.

When should kids have their eyes examined?

According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. Children then should receive additional eye exams at 3 years of age, and just before they enter kindergarten or the first grade at about age 5 or 6.

For school-aged children, the AOA recommends an eye exam every two years if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or according to their eye doctor's recommendations.

Early eye exams also are important because children need the following basic visual skills for learning:

  • Near vision
  • Distance vision
  • Eye teaming (binocularity) skills
  • Eye movement skills
  • Focusing skills
  • Peripheral awareness
  • Eye/hand coordination

Because of the importance of good vision for learning, some states require an eye exam for all children entering school for the first time.

Scheduling your child's eye exam

Your family doctor or pediatrician likely will be the first medical professional to examine your child's eyes. If eye problems are suspected during routine physical examinations, a referral might be made to an ophthalmologist or optometrist for further evaluation. Eye doctors have specific equipment and training to help them detect and diagnose potential vision problems.

When scheduling an eye exam, choose a time when your child is usually alert and happy. Specifics of how eye exams are conducted depend on your child's age, but an exam generally will involve a case history, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, an eye health examination and a consultation with you regarding the findings.

After you've made the appointment, you may be sent a case history form by mail, or you may be given one when you check in at the doctor's office. The case history form will ask about your child's birth history (also called perinatal history), such as birth weight and whether or not the child was full-term. Your eye doctor also may ask whether complications occurred during the pregnancy or delivery. The form will also inquire about your child's medical history, including current medications and past or present allergies.

Be sure to tell your eye doctor if your child has a history of prematurity, has delayed motor development, engages in frequent eye rubbing, blinks excessively, fails to maintain eye contact, cannot seem to maintain a gaze (fixation) while looking at objects, has poor eye tracking skills or has failed a pediatrician or pre-school vision screening.

Your eye doctor will also want to know about previous ocular diagnoses and treatments involving your child, such as possible surgeries and glasses or contact lens wear. Be sure you inform your eye doctor if there is a family history of eye problems requiring vision correction, such as nearsightedness or farsightedness, misaligned eyes (strabismus) or amblyopia ("lazy eye").

Eye testing for infants

It takes some time for a baby's vision skills to develop. To assess whether your infant's eyes are developing normally, your eye doctor may use one or more of the following tests:

  • Tests of pupil responses evaluate whether the eye's pupil opens and closes properly in the presence or absence of light.
     
  • "Fixate and follow" testing determines whether your baby can fixate on an object (such as a light) and follow it as it moves. Infants should be able to perform this task quite well by the time they are 3 months old.
     
  • Preferential looking involves using cards that are blank on one side with stripes on the other side to attract the gaze of an infant to the stripes. In this way, vision capabilities can be assessed.

Eye testing for pre-school children

Pre-school children can have their eyes thoroughly tested even if they don't yet know the alphabet or are too young or too shy to answer the doctor's questions. Some common eye tests used specifically for young children include:

  • LEA Symbols for young children are similar to regular eye tests using charts with letters, except that special symbols in these tests include an apple, house, square and circle.
     
  • Retinoscopy is a test that involves shining a light into the eye to observing how it reflects from the retina (the light-sensitive inner lining of the back of the eye). This test helps eye doctors determine the child's eyeglass prescription.
     
  • Random Dot Stereopsis uses dot patterns to determine how well the two eyes work as a team.

Eye and vision problems that affect children

Besides looking for nearsightedness, farsightedness and astigmatism (refractive errors), your eye doctor will be examining your child's eyes for signs of these eye and vision problems commonly found in young children:

        Amblyopia. Also commonly called "lazy eye," this is decreased vision in one or both eyes despite the absence of any eye health problem or damage. Common causes of amblyopia include strabismus (see below) and a significant difference in the refractive errors of the two eyes. Treatment of amblyopia may include patching the dominant eye to strengthen the weaker eye.

 

        Strabismus. This is misalignment of the eyes, often caused by a congenital defect in the positioning or strength of muscles that are attached to the eye and which control eye positioning and movement. Left untreated, strabismus can cause amblyopia in the misaligned eye. Depending on its cause and severity, surgery may be required to treat strabismus.

 

        Convergence insufficiency. This is the inability to keep the eye comfortably aligned for reading and other near tasks. Convergence insufficiency can often be successfully treated with vision therapy, a specific program of eye exercises.

 

        Focusing problems. Children with focusing problems (also called accommodation problems) may have trouble changing focus from distance to near and back again (accommodative infacility) or have problems maintaining adequate focus for reading (accommodative insufficiency). These problems often can be successfully treated with vision therapy.

 

        Eye teaming problems. Many eye teaming (binocularity) problems are more subtle than strabismus. Deficiencies in eye teaming skills can cause problems with depth perception and coordination.

Vision and learning

Experts say that 80% of what your child learns in school is presented visually. Undetected vision problems can put them at a significant disadvantage. Be sure to schedule a complete eye exam for your child prior to the start of school.

For more information on eye exams and vision problems, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

Preparing for an Eye Exam

Eyecare experts recommend you have a complete eye exam every one to three years, depending on your age, risk factors, and physical condition.

Children. Some experts estimate that approximately 5 percent to 10 percent of pre-schoolers and 25 percent of school-aged children have vision problems. According to the American Optometric Association (AOA), all children should have their eyes examined at 6 months of age, at age 3 and again at the start of school. Children without vision problems or risk factors for eye or vision problems should then continue to have their eyes examined at least every two years throughout school.

Children with existing vision problems or risk factors should have their eyes examined more frequently. Common risk factors for vision problems include:

  • premature birth
  • developmental delays
  • turned or crossed eyes
  • family history of eye disease
  • history of eye injury
  • other physical illness or disease

The AOA recommends that children who wear eyeglasses or contact lenses should have their eyes examined at least every 12 months or according to their eye doctor's instructions.

Adults. The AOA also recommends an annual eye exam for any adult who wears eyeglasses or contacts. If you don't normally need vision correction, you still need an eye exam every two to three years up to the age of 40, depending on your rate of visual change and overall health. Doctors often recommend more frequent examinations for adults with diabetes, high blood pressure and other disorders, because many diseases can have an impact on vision and eye health.

If you are over 40, it's a good idea to have your eyes examined every one to two years to check for common age-related eye problems such as presbyopia, cataracts and macular degeneration.

Because the risk of eye disease continues to increase with advancing age, everyone over the age of 60 should be examined annually.

Who should I see for my eye exam?

There are two kinds of eye doctors – ophthalmologists and optometrists. Who you should see depends on your needs and preferences.

Ophthalmologists are medical doctors (MDs or DOs) who specialize in eyecare. In addition to prescribing eyeglasses and contacts, ophthalmologists are licensed to perform eye surgery and treat medical conditions of the eye. Ophthalmologists generally undergo eight or more years of training after college.

Optometrists (ODs) are eye doctors who can prescribe glasses and contacts and treat medical conditions of the eye with eye drops and other medicines. They are not licensed to perform eye surgery. Optometrists generally receive four or more years of training after college.

How much does an eye exam cost?

Eye exams are available in many settings, from discount optical stores to surgical offices, so the fees can vary widely. Additionally, fees can vary depending upon whether the exam is performed by an optometrist or an ophthalmologist, and the type of services that are included in the exam.

Generally speaking, contact lens exams cost more than regular eye exams. Likewise, an additional or higher fee may be charged for specialized services such as laser vision correction evaluations.

Many insurance plans cover at least a portion of eye exam services. Check to see what your benefits are and which eye doctors in your area participate in your plan before you make an appointment. Then be sure to give your doctor's office your insurance information to verify coverage.

What information should I take with me to my eye exam?

It's important to have some basic information ready at the time of your eye examination. Bring the following items to your exam:

        All eyeglasses and contact lenses you routinely use, including reading glasses.

        A list of any medications you take (including dosages).

        A list of any nutritional supplements you take (including dosages).

        A list of questions to ask the doctor, especially if you are interested in contact lenses or laser vision correction surgery.

Finally, also bring your medical or vision insurance card if you will be using it for a portion of your fees.

For more information on eye exams, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Why Are Eye Exams Important?

Regardless of your age or physical health, it's important to have regular eye exams.

During a complete eye exam, your eye doctor will not only determine your prescription for eyeglasses or contact lenses, but will also check your eyes for common eye diseases, assess how your eyes work together as a team and evaluate your eyes as an indicator of your overall health.

Who should get their eyes examined?

Eye examinations are an important part of health maintenance for everyone. Adults should have their eyes tested to keep their prescriptions current and to check for early signs of eye disease. For children, eye exams can play an important role in normal development.

Vision is closely linked to the learning process. Children who have trouble seeing or interpreting what they see will often have trouble with their schoolwork. Many times, children will not complain of vision problems simply because they don't know what "normal" vision looks like. If your child performs poorly at school or exhibits a reading or learning problem, be sure to schedule an eye examination to rule out an underlying visual cause.

What is the eye doctor checking for?

In addition to evaluating whether you have nearsightedness, farsightedness or astigmatism, your eye doctor will check your eyes for eye diseases and other problems that could lead to vision loss. Here are some examples of the conditions that your eye doctor will be looking for: 

  • Amblyopia: This occurs when the eyes are misaligned or when one eye has a much different prescription than the other. The brain will "shut off" the image from the turned or blurry eye. If left untreated, amblyopia can stunt the visual development of the affected eye, resulting in permanent vision impairment. Amblyopia is often treated by patching the stronger eye for periods of time.
     
  • Strabismus: Strabismus is defined as crossed or turned eyes. Your eye doctor will check your eyes' alignment to be sure that they are working together. Strabismus causes problems with depth perception and can lead to amblyopia.
     
  • Eye Diseases: Many eye diseases, such as glaucoma and diabetic eye disease, have no obvious symptoms in their early stages. Your eye doctor will check the health of your eyes inside and out for signs of early problems. In most cases, early detection and treatment of eye diseases can help reduce your risk for permanent vision loss.
     
  • Other Diseases: Your eye doctor can detect early signs of some systemic conditions and diseases by looking at your eye's blood vessels, retina and so forth. They may be able to tell you if you are developing high blood pressure, high cholesterol or other problems.
     
    For example, diabetes can cause small blood vessel leaks or bleeding in the eye, as well as swelling of the macula (the most sensitive part of the retina), which can lead to vision loss. It's estimated that one-third of Americans who have diabetes don't know it; your eye doctor may detect the disease before your primary care physician does, especially if you're overdue for a physical.

What's the difference between a vision screening and a complete eye exam?

Vision screenings are general eye tests that are meant to help identify people who are at risk for vision problems. Screenings include brief vision tests performed by a school nurse, pediatrician or volunteers. The eye test you take when you get your driver's license renewed is another example of a vision screening.

A vision screening can indicate that you need to get an eye exam, but it does not serve as a substitute for a comprehensive eye exam.

A comprehensive eye examination is performed by an eye doctor and will involve careful testing of all aspects of your vision. Based upon the results of your exam, your doctor will then recommend a treatment plan for your individual needs. Remember, only an eye doctor can provide a comprehensive eye exam. Most family physicians and pediatricians are not fully trained to do this, and studies have shown that they can miss important vision problems that require treatment.

Treatment plans can include eyeglasses or contact lenses, eye exercises or surgery for muscle problems, medical treatment for eye disease or simply a recommendation that you have your eyes examined again in a specified period of time.

No matter who you are, regular eye exams are important for seeing more clearly, learning more easily and preserving your vision for life.

For more information on eye exams, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Your Comprehensive Eye Exam

A comprehensive eye exam includes a number of tests and procedures to examine and evaluate the health of your eyes and the quality of your vision. These tests range from simple ones, like having you read an eye chart, to complex tests, such as using a high-powered lens to examine the health of the tissues inside of your eyes.

 Here are some tests you are likely to encounter during a routine comprehensive eye exam:

Retinoscopy

This test helps your doctor get a good approximation of your eyeglasses prescription. For retinoscopy, the room lights are dimmed and an instrument containing wheels of lenses (called a phoropter) is positioned in front of your eyes. You will be asked to look at an object across the room (usually the big "E" on the wall chart or screen) while your doctor shines a light from a hand-held instrument into your eyes from arm's length and flips different lenses in front of your eyes.

Based on the way the light reflects from your eye during this procedure, your doctor can get a very good idea of what your eyeglasses prescription should be. This test is especially useful for children and non-verbal patients who are unable to accurately answer the doctor's questions.

With the widespread use of automated instruments to help determine eyeglass prescriptions today, many doctors forgo performing retinoscopy during comprehensive eye exams. However, this test can provide valuable information about the clarity of the internal lens and other media inside the eye. So doctors who no longer perform this test routinely may still use it when examining someone who may be at risk of cataracts or other internal eye problems.  

Refraction

This is the test your doctor uses to determine your exact eyeglasses prescription. During a refraction, the doctor puts the phoropter in front of your eyes and shows you a series of lens choices. He or she will then ask you which of the two lenses in each choice ("1 or 2," "A or B," for example) make the letters on the wall chart look clearer.

Based on your answers, your doctor will determine the amount of nearsightedness, farsightedness and/or astigmatism you have, and the eyeglass lenses required to correct these vision problems (which are called refractive errors).

Autorefractors and aberrometers

Your eye doctor also may use an autorefractor or aberrometer to help determine your glasses prescription. With both devices, a chin rest stabilizes your head while you typically look at a pinpoint of light or other image.

An autorefractor evaluates the way an image is focused on the retina, where vision processing takes place, without the need for you to say anything. This makes autorefractors especially useful when examining young children or people who may have difficulty with a regular ("subjective") refraction. Automated refractions and subjective refractions are often used together during a comprehensive exam to determine your eyeglasses prescription.

An aberrometer uses advanced wavefront technology to detect even obscure vision errors based on the way light travels through your eye.

Cover test

While there are many ways for your eye doctor to check how your eyes work together, the cover test is the simplest and most common.

During a cover test, the eye doctor will have you focus on a small object at distance and will then cover each of your eyes alternately while you stare at the target. As they do this, eye doctors observe how much each eye has to move when uncovered to pick up the fixation target. The test is then repeated as you focus on a near object.

Cover tests can detect even very subtle misalignments that can interfere with your eyes working together properly (binocular vision) and cause amblyopia or "lazy eye."

Slit-lamp examination

The slit lamp is an instrument that the eye doctor uses to examine the health of your eyes. Also called a biomicroscope, the slit lamp gives your doctor a highly magnified view of the structures of the eye, including the lens behind the pupil, in order to thoroughly evaluate them for signs of infection or disease.

The slit lamp is basically an illuminated binocular microscope that's mounted on a table and includes a chin rest and head band to position the patient's head properly. With the help of hand-held lenses, your doctor can also use the slit lamp to examine the retina (the light-sensitive inner lining of the back of the eye.)

Tonometry (glaucoma testing)

Tonometry is the name for a variety of tests that can be performed to determine the pressure inside the eye. Elevated internal eye pressure can cause glaucoma, which is vision loss due to damage to the sensitive optic nerve in the back of the eye.

The most common method used for tonometry is the "air puff" test – where an automated instrument discharges a small burst of air to the surface of your eye. Based on your eye's resistance to the puff of air, the machine calculates the pressure inside your eye – called your intraocular pressure (IOP).

Though the test itself can be startling, nothing but air touches your eye during this measurement and there's no risk of eye injury from the air puff test.

Another popular way to measure eye pressure is with an instrument called an applanation tonometer, which is usually attached to a slit lamp. For this test, a yellow eye drop is placed on your eyes. Your eyes will feel slightly heavy when the drops start working. This is not a dilating drop — it is simply a numbing agent combined with a yellow dye. Then the doctor will have you stare straight ahead in the slit lamp while he or she gently rests the bright-blue glowing probe of the tonometer on the front of each eye and manually measures the intraocular pressure.

Like the air puff test, applanation tonometry is painless and takes just a few seconds.

Since glaucoma is often the result of an increase of pressure inside the eye, these are important tests for ensuring the long-term health of your eyes.

Pupil dilation

Your comprehensive exam may include the use of dilating drops. These medicated eye drops enlargen your pupil so your doctor can get a better view of the internal structures in the back of the eye. Dilating drops usually take about 20 minutes to start working. When your pupils are dilated, you will be sensitive to light, because more light is getting into your eye. You may also notice difficulty reading or focusing on close objects. These effects can last for up to several hours, depending on the strength of the drops used.

If you don't have sunglasses to wear after the exam, disposable sunglasses will be provided to help you drive home. Dilation is very important for people with risk factors for eye disease, because it allows for a more thorough evaluation of the health of the inside of your eyes.

Summary

These are the most common tests performed during a standard comprehensive eye exam. Depending on your particular needs, your doctor may perform additional tests or schedule them to be performed at a later date.

For more information on eye exams or eye diseases, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Eyeglasses

Eyeglass Frames Materials

Finding eyeglasses with the qualities that are most important to you could be as simple as choosing a frame material, each distinguished by its own strengths.

You can also choose frames based on factors such as color, hypoallergenic materials, durability, lightness, price and uniqueness.

Metal frames

Metal is the most popular material for eyeglass frames. There are many types of metal you can choose, with each having its own distinctive properties.

Titanium. This premium metal is very strong, durable, corrosion-resistant, and is 40% lighter than other metals. It's also hypoallergenic, making it a nearly perfect material for eyeglass frames. Titanium frames are available in several colors.

Beta titanium. This is an alloy of predominantly titanium, with small amounts of aluminum and vanadium. These other metals in the alloy make beta titanium more flexible than 100% titanium for easier fitting adjustments.

Memory metal. This is a titanium alloy composed of roughly 50% titanium and 50% nickel. Frames made of memory metal are extremely flexible, and can be twisted or bended to an extreme and still return to their original shape. This feature makes memory metal frames great for kids or anyone who is hard on their glasses.

Beryllium. This lower-cost alternative to titanium resists corrosion and tarnishing, making it an excellent choice for anyone with high skin acidity or who spends a good amount of time in or around salt water. It's also lightweight, strong, flexible and available in a wide range of colors.

Stainless steel. This is an iron-carbon alloy that also contains chromium. Stainless steel frames are lightweight, strong, durable, flexible and corrosion-resistant. They also can be produced in matte or polished finishes.

Monel. This popular, inexpensive material is an alloy of nickel and copper. It is less costly than other metals, but – depending on the quality of the plating used – Monel frames may or may not discolor and cause skin reactions over time.

Plastic frames

Zyl. This material (also called Zylonite or cellulose acetate) is a lightweight and relatively inexpensive type of plastic. It's also the most popular plastic used for eyeglass frames. Zyl frames are available in a wide variety of colors, including multi-colored models and frames with different layers of color.

Propionate. This is a nylon-based plastic that is strong, flexible, lightweight and hypoallergenic. Propionate is often used in sports frames because of its durability.

Nylon. This frame material is still occasionally used. Nylon is strong, lightweight and flexible, but it can become brittle with age. For this reason, it has for the most part been replaced by nylon blends – polyamides, copolyamides and gliamides – which are more durable.

Combination frames

As you might guess, these are frames that have both metal and plastic components. Popular in the 1950s and 1960s, combination frames have made a comeback recently, in a wider variety of colors than the classic models.

Mix it up!

Each frame material offers its own advantages and style features. For eyewear that fits every occasion in your life, consider purchasing more than one pair of glasses and choose a different frame material for each pair.

For example, you may want a conservative-style frame made of durable, lightweight titanium for work. But on weekends, you may want something with more color or style, like a zyl frame in laminated colors, or a combination frame with a modern spin of that classic retro-look.

For more information on eyeglass frames, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Lens Options for Eyeglasses

When it comes to choosing eyeglass lenses, it's no longer a simple choice of "glass or plastic?" Let's look at your many options in eyeglass lenses in detail:

Want thinner, lighter lenses? Choose a high index lens material.

Nearly everyone can benefit from thinner, lighter lenses. High index lenses can be up to 50% thinner than regular glass or plastic lenses, and they're usually much lighter, too.

Though these lenses are especially beneficial if you have a strong eyeglasses prescription, they can make a noticeable difference in the appearance of virtually any pair of glasses. High index lenses bend light more efficiently than regular glass or plastic lenses, so less lens material is required to correct your vision.

Various high index lenses are available today in different price points based on how much thinner they are compared to regular plastic lenses. The lenses are classified by their "index of refraction" (or "refractive index").

Generally, lenses with a higher index of refraction will be thinner (and usually more expensive) than lenses with a lower index. The index of refraction of regular plastic lenses is 1.50. The refractive index of high index plastic lenses ranges from 1.53 to 1.74. Those in the range of 1.53 to 1.59 are about 20% thinner than regular plastic lenses, whereas 1.74 high index lenses are about half the thickness of regular plastic lenses.

Most popular lens designs (single vision, bifocal, progressive, photochromic, etc.) come in high-index materials, and your doctor or optician will know which ones are available in your prescription. Bifocal and trifocal high index lenses are also available, though the selection is more limited.

Note: High index lenses reflect more light than regular glass or plastic lenses, so anti-reflective (AR) coating is highly recommended for these lenses (see below).

Slim down with aspheric lenses

To make high index lenses even more attractive, most of them have an "aspheric" design. This means that instead of having a round (or "spherical") curve on the front surface, these lenses have a curve that gradually changes from the center to the lens to the periphery. This makes aspheric lenses noticeably flatter for a slimmer, more attractive lens profile.

Though aspheric lenses offer advantages for all prescriptions, they are particularly beneficial if you are farsighted. Aspheric lenses greatly reduce the magnified, "bug-eye" look caused by regular, highly curved lenses for farsightedness, and they greatly reduce the "bulge" of the lenses from the frame. And because they have a slim profile, aspheric lenses have less lens mass, making them much lighter. Aspheric lenses also provide superior peripheral vision compared to conventional lenses.

Note: Because they have flatter curves than regular lenses, aspheric lenses may cause more noticeable reflections. Anti-reflective (AR) coating is recommended for these lenses (see below).

Polycarbonate and Trivex lenses: Tough as nails

Polycarbonate and Trivex lenses are special high index lenses that offer superior impact resistance. These lenses are up to 10 times more impact resistant than regular plastic lenses, making them an ideal choice for children's eyewear, safety glasses, and for anyone with an active lifestyle who wants a thinner, lighter, safer lens.

Polycarbonate lenses have a refractive index of 1.59, making them 20% to 25% thinner than regular plastic lenses. They are also up to 30% lighter than regular plastic lenses, making them a good choice for anyone who is sensitive to the weight of eyeglasses on their nose.

Trivex lenses may be slightly thicker than polycarbonate lenses, but they provide comparable impact resistance and, like polycarbonate lenses, they block 100% of the sun's harmful UV rays.

AR coating: Better vision, better appearance

All eyeglass lenses reflect some light, reducing the amount of light that enters the eye to form visual images. This can have an impact on vision, especially under low-light conditions, like when driving at night. Lens reflections can also cause glare, further reducing vision in these situations.

The amount of light reflected depends on the lens material. Conventional glass or plastic lenses reflect about 8% of incident light, so only 92% of available light enters the eye for vision. Thinner, lighter lenses made of high index materials reflect up to 50% more light than regular glass or plastic lenses (up to 12% of available light).

Anti-reflective (AR) coating reduces lens reflections and allows more light to enter the eye for better night vision. Regardless of the lens material, eyeglass lenses with AR coating transmit over 99% of available light to the eye.

By eliminating surface reflections, anti-reflective coating also makes your lenses nearly invisible. This greatly improves the appearance of your eyewear and allows others to see your eyes, not the reflections in your glasses.

When cleaning lenses with anti-reflective coating, be sure to use the products recommended by your optician. Because AR coating eliminates reflections that can hide small scratches, you'll want to take care not to scratch AR-coated lenses, as scratches on these lenses may be more visible than scratches on an uncoated lens.

Scratch-resistant coatings

No eyeglass lens material – not even glass – is scratch-proof. However, a lens that is treated front and back with a clear, hard coating does become more resistant to scratching, whether it's from dropping your glasses on the floor or occasionally cleaning them with a paper towel. Kids' lenses, especially, benefit from a scratch-resistant hard coat.

Nearly all high index lenses (including polycarbonate) come with a factory-applied scratch-resistant coating for added durability. This coating is optional for regular plastic lenses. However, to safeguard your investment in your eyewear, scratch-resistant coating should be considered for all eyeglass lenses. The only exception is glass lenses, which are naturally hard and scratch-resistant.

To further protect your eyeglasses from scratches, keep your glasses in a protective case when you're not wearing them. Also, never clean your lenses without first rinsing them with a cleaning solution or water. Rubbing a dry, dusty or dirty lens with a cleaning cloth or towel can cause scratches, even on lenses with a scratch-resistant coating.

Ultraviolet (UV) treatment

Just as you use sunscreen to keep the sun's UV rays from harming your skin, UV treatment in eyeglass lenses blocks those same rays from damaging your eyes. Overexposure to ultraviolet light is thought to be a cause of cataracts, retinal damage and other eye problems.

Most high index lenses have 100% UV protection built-in. But with regular plastic lenses, a lens treatment is required for these lenses to block all UV rays. This UV treatment does not change the appearance of the lenses and is quite inexpensive.

Photochromic lenses: Right in any light

Photochromic lenses are convenient indoor-outdoor eyeglass lenses that automatically darken to a sunglass shade outside when exposed to sunlight, and then quickly return to a clear state indoors. These lenses also provide 100% protection from the sun's UV rays, and are available in a wide variety of lens materials and designs, including bifocal and progressive lenses.

The amount of darkening that most photochromic lenses undergo depends on how much UV radiation they are exposed to. As a general rule, these lenses won't get as dark behind the windshield of your car or truck because the glass blocks out much of the sun's UV rays that cause the lenses to change color.

We're here to help!

With so many new lens products available, it's hard to know all your options and decide which lenses are best for you. Rely on our expertise to make selecting your eyeglasses easy and fun. Our trained staff welcomes the opportunity to help you find the perfect eyewear for your personal style and vision requirements.

For more information on eyeglass lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Men's Eyeglass Frames

Most men are interested in comfort, fit and durability when it comes to eyeglasses. While they also want style, men typically won't forsake comfort and fit just to look good.

Comfort and fit

Men: Here are some key areas to check out to make sure the eyeglass frames you choose will be comfortable and fit well.

To ensure the temples (the pieces that extend to your ears) aren't too snug on sides of your head, choose frames are wide enough for your face. The edge of the frames should protrude slightly beyond your face so the temples don't put pressure on your head as they extend back to your ears.

Next, make sure the temples are long enough. Many frame styles are available in more than one temple length. So if you find a frame you like but the temples seem too short, ask your optician if a longer temple is available. For a comfortable fit, the curve at the end of the temple should extend over your ear without pressing down upon it.

Also, check the nosepiece for comfort and fit. Many glasses have soft, silicone nose pads that can be adjusted for a customized fit. For frames without adjustable nose pads, the frame should fit securely without pinching the bridge of your nose.

When you pick up your new eyeglasses, move your head up and down, and bend over (as if to pick up something up from the floor) to see how well your glasses stay in place. With properly adjusted nose pads and temples, your glasses should stay comfortably in place.

Durability

For extra-durable eyeglasses, consider choosing frames made from titanium, stainless steel or "memory metal." Titanium and stainless steel are stronger and more durable than other metal frame materials, and frames made of memory metal, a titanium-based alloy, return to their original shape even if they are severely bent or twisted.

What about fashion? Five trends in men's eyeglasses

Men's frame styling has become more masculine in recent years, with classic shapes and sizes now re-born with a modern twist.

  1. Masculine shapes such as aviator glasses and double brow-bar styles have seen a resurgence in popularity, but in fresh colors and materials and slightly pared-down in size.
     
  2. Larger and bolder eyeglass frames are becoming popular again for men. Keep in mind that the biggest styles work best on men with larger body types. Smaller frames are still around, and still work well with smaller faces.
     
  3. Rimless and semi-rimless styles (where the eyeglass lens is held in place to the temple simply by a screw or a wire) are perfect for the man who wants a modern or minimalist look. Combine rimless frames with anti-reflective lenses and the glasses practically disappear. 

 

  1. Titanium frames are very popular with men and rate high in both the function and fashion categories. These premium metal frames are super lightweight, non-corrosive, very durable and stylish as well.
     
  2. For a younger, hip or retro look, many men are turning to plastic frames. Lightweight and comfortable, plastic frames come in a wide variety of styles including bold, black '50s-style frames and modern designs with layers of colors laminated together to create a unique effect.

Time to upgrade?

Are your glasses uncomfortable? Want a new look? Visit us today to see the latest styles comfortable, fashionable frames for men of all ages.

For more information on men's eyeglasses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Specialty Eyewear

Just as "one-size-fits-all" doesn't always fit, neither does one pair of eyeglasses for all situations.

Whether you want optimum vision and comfort for a specific activity, such as computer use, work, hobbies or driving, or you need glasses that provide an extra margin of safety for work or recreation, special-purpose eyeglasses will usually meet these needs better than your "everyday" glasses.

Computer glasses

If you spend much time in front of a computer, you probably already know that eye strain, fatigue and muscle strains are common problems associated with prolonged computer use. "Computer glasses" have lenses that are specially-designed to maximize your vision at the intermediate and close-up distances you use during computer work. Computer-specific eyewear will give you the best correction for these distances and help reduce eyestrain.

Reading and hobbies

If you wear bifocals, you may find you have to tip your head back slightly to use the reading portion of the lens. That's fine for most things, but if you want to sit and read a novel, this head-back posture can cause neck discomfort and fatigue. Often, a pair of single vision reading glasses are a much better solution for prolonged reading and other detailed near vision tasks, such as sewing or needlepoint work.

Working in the yard or with power tools

Lawn mowers, power trimmers, grinding tools and other power tools can all cause serious eye injuries from high-speed projectiles. Even something as simple as hammering a nail can cause flying debris. Safety glasses are a must for these activities.

Sports eyewear

Did you know that wearing specially-tinted eyeglass lenses can improve your visual acuity on the tennis court, golf course or on the slopes? Sport-specific eyewear can enhance performance by improving visual clarity while protecting your eyes from injury.

Driving glasses

Driving glasses come in two different categories: sunglasses designed specifically for driving and clear prescription driving glasses. Many sunglasses made for driving feature polarized lenses to reduce glare and special tints to enhance contrast for safer, more comfortable vision on the road on sunny days. Eyeglasses for night driving should include your distance prescription and anti-reflective (AR) coating to reduce the glare from streetlights and oncoming headlights and allow more light to reach your eyes for better vision on dark roadways.

We can help

Nearly everyone can benefit from specialty eyewear. Let us know about all the different things you like to do, and we can tell you about the best special-purpose eyewear to fit your needs.

For more information on computer glasses and safety glasses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

The Basics of Eyeglasses

Eyeglasses are more popular today than ever, despite the availability of contact lenses and vision correction surgery.

Frame styles branded with high profile designer names are always in demand. And eyeglass frame materials have evolved with the advent of new plastics and various types of metals.

For safety glasses, you may want an extra tough plastic, such as polycarbonate. If you suffer from skin allergies, hypoallergenic metals such as titanium or stainless steel are good choices.

Certain frames are made with highly flexible metal alloys, which reduce the possibility of breakage. Spring hinges are also for added durability, and are a great option for children's eyewear.

Eyeglass frames styles

Eyeglasses have also become quite popular as fashion accessories, with different colors and styles available to match their wardrobes.

Multi-colored inlays, composite materials, designer emblems, and enhancements such as insets of precious stones may also be found in popular frame styles.

Rimless styles have become more popular in recent years as an understated way to wear eyeglasses without obvious frames. Rimless styles mainly involve attaching plastic or metal temples directly onto the lenses rather than onto a frame.

Advances in eyeglass lenses

You also have many options when choosing the lenses for your eyeglasses. Among the most popular types of lenses and lens options prescribed today are:

  • Aspheric lenses, which have a slimmer, more attractive profile than other lenses. They also eliminate that magnified, "bug-eye" look caused by some prescriptions.

  • High index lenses, which are made of new materials that enable the lenses to be noticeably thinner and lighter than regular plastic lenses.

  • Polycarbonate lenses are thinner, lighter and up to 10 times more impact-resistant than regular plastic lenses. These lenses are great for safety glasses, children's eyewear, and for anyone who wants lightweight, durable lenses.

  • Photochromic lenses are sun-sensitive lenses that quickly darken in bright conditions, and quickly return to a clear state in ordinary indoor lighting.

  • Polarized lenses diminish glare from flat, reflective surfaces (like water) and also reduce eye fatigue.

  • Anti-reflective coatings are among the most popular add-ons for lenses. They can dramatically improve the look and comfort of your glasses by minimizing the amount of light that reflects off the surface of your lenses, which also has the added benefit of reducing glare and thus easing eye fatigue.

  • Other lens coatings include scratch-resistant, ultraviolet treatment, and mirror coatings.

Eyeglass lenses for presbyopia

Presbyopia is the normal, age-related loss of near focusing ability that makes reading and other close-up tasks more difficult after age 40.

This means that the usual type of eyeglass lenses you've likely been accustomed to wearing, known as single vision lenses, no longer will work well for you.

Multifocal eyeglass lenses available for presbyopia correction include:

  • Bifocals: Lenses with two powers – one for distance and one for near – separated by a visible line.

  • Trifocals: Lenses with three powers for seeing at varying distances – near, intermediate and far – separated by two visible lines.

  • Progressive lenses: These lenses have many advantages over bifocals and trifocals because they allow the wearer to focus at many different distances, not just two or three. Because they have no lines, progressive lenses allow a smooth, comfortable transition from one distance to another.

 If you see well in the distance without the need for eyeglasses, simple reading glasses with single vision lenses may be all you need to deal with near vision problems caused by presbyopia. 

Advice for Buying Eyeglasses

Your appearance, personal taste and lifestyle should all be considered when choosing eyeglasses. We can help you choose frames and lenses that both complement your appearance and meet your lifestyle needs.

For more information on prescription eyeglasses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Women's Eyeglass Frames

Need new eyeglasses? The choices in women's frames are nearly unlimited. But that's sometimes the problem: How do you find the frames styles that look best on you?

Narrowing down your choices

Ask yourself a few questions before shopping for eyewear:

        Do I want a frame that's delicate or bold, retro or modern, conservative or "out there"?

        Do I plan to wear this frame at work? For social occasions?

        What colors am I drawn to and look best on me?

        What are the main colors in my wardrobe?

        What face shape do I have?

        What do I like about my current eyeglasses? What do I dislike?

The answers to these questions will help your optician narrow your search to frames that you are most likely to be happy with.

Judging fit and comfort

According to eyewear industry research, most women are more interested in the way eyeglasses look, while most men are more interested in comfort and fit. But let's face it. If the frame doesn't fit well or isn't comfortable, you won't want to wear it.

Here are some tips about how to judge the fit of frames:

  • To ensure the temples aren't too snug on sides of your head, choose frames that are wide enough for your face. The edge of the frames should protrude slightly beyond your face so the temples don't put pressure on your head as they extend back to your ears.
  • Are the temples long enough? The curve at the end of the temple should extend over your ear without pressing down upon it.
  • Check the nosepiece for comfort and fit. Many glasses have soft, silicone nose pads that can be adjusted for a customized fit. For frames without adjustable nose pads, the frame should fit securely without pinching the bridge of your nose.
  • When you pick up your new eyeglasses, move your head up and down, and bend over (as if to pick up something up from the floor) to see how well your glasses stay in place. With the properly adjusted nose pads and temples, your glasses should stay comfortably in place.

How many frames do you need?

Most women don't hesitate to buy more than one pair of shoes, so why balk at buying more than one pair of eyeglasses?

Your eyewear is as much a fashion accessory as anything else you wear. And while few of us have an unlimited budget, money spent on multiple pairs of eyeglasses is well spent – especially if you have a varied wardrobe for work, home and social wear.

If you're really on a tight budget, then by all means choose one frame that you'll be happy wearing with any outfit and in any situation. But it doesn't mean you have to choose a plain, thin metal frame if you really like eyewear that's bold and colorful. Remember, this frame is going to be on your face every single day, and you have to like how it looks on you.

Let us help

Our optical dispensary has a large selection of the latest styles in women's frames. We can help you find the best eyewear to complement your facial features, shape and coloring, and help you choose frames that match your personality and wardrobe.

For more information on eyeglasses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

LASIK and Vision Surgery

Cornea Transplant

A corneal transplant – also called keratoplasty (KP), penetrating keratoplasty (PKP), or corneal graft – is the surgical removal of the central portion of the cornea (the normally clear front surface of the eye) followed by replacement with a donor "button" of clear corneal tissue from an eye bank.

Corneal transplants are performed when, because of disease or injury, the cornea becomes scarred or damaged in such a way that it causes vision problems that cannot be corrected with eyeglasses, contact lenses, or refractive surgery such as LASIK.

The National Eye Institute estimates that approximately 40,000 corneal transplants are performed each year in the United States. The success rate for keratoplasty is quite high, but up to 20% of patients may reject their donor corneas. When signs of rejection occur, aggressive medical treatment with steroids can often overcome the reaction and save the cornea. Some studies report keratoplasty success rates of 95% to 99% at 5 to 10 years after surgery.

Reasons for corneal transplants

A common cause for keratoplasty is keratoconus, a degenerative condition in which the cornea becomes thinner and bulges forward in an irregular cone shape. In mild cases, keratoconus can be treated with rigid gas permeable (GP) contact lenses.

But in advanced stages of the condition, the contact lenses can no longer be tolerated on the eye. Vision with GP lenses also becomes unacceptable due to the high degree of corneal irregularity.  According to the National Keratoconus Foundation, 20 to 25 percent of patients with keratoconus will require corneal transplant surgery to restore vision.

Other indications for keratoplasty include traumatic injuries to the eye and corneal scarring from infections, chemical burns or other causes. A corneal transplant also may be required in cases of corneal degenerative diseases and corneal ectasia (thinning and bulging of the cornea that is similar to keratoconus) after LASIK or other laser vision correction surgery.

The corneal transplant procedure

Typically, corneal transplants are performed on an outpatient basis, meaning you will not need overnight hospitalization. Local or general anesthesia is used, depending on your health, age and whether or not you prefer to be asleep during the procedure. The surgeon uses a trephine (an instrument like a cookie cutter) or a laser to cut and remove a round area of damaged or diseased tissue in the center of your cornea, and replaces it with the clear donor tissue.

The donor "button" is attached to your remaining cornea with very fine sutures (less than half the thickness of a human hair). These sutures stay in place for months or even years, until the eye is fully healed and stable.

Recovering from a corneal transplant

The total recovery time for a corneal transplant may be up to a year or longer. Initially, your vision will be blurry and the site of your corneal transplant may be swollen and slightly thicker than the rest of your cornea. Eye drops to promote healing and help your body accept the new corneal graft will be needed for several months.

You should keep your eye protected at all times after surgery by wearing a shield or a pair of eyeglasses so that nothing inadvertently bumps your eye. As your vision improves, you will gradually be able to return to your normal daily activities.

Vision after keratoplasty

Some patients notice improvement in their vision the day following surgery. However, large amounts of astigmatism are common after a corneal transplant. Your vision and eyeglasses prescription will fluctuate for several months after surgery, and vision changes may persist for up to a year.

Gas permeable contact lenses usually provide the best vision correction after keratoplasty, as some irregularity of the corneal surface is common. Glasses with polycarbonate lenses should be worn over the contact lenses for eye protection.

After healing is complete and the sutures are removed, it may be possible to have LASIK or some other laser vision correction procedure to reduce astigmatism and enhance your ability to see without glasses or contact lenses.

For more information on corneal transplants or keratoconus, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Corneal Inlays and Onlays

Corneal inlays and onlays are small lenses or optical devices that can be inserted into the cornea to alter its shape and correct vision problems.

Though these devices and the surgical procedures associated with them are not yet FDA-approved for use in the United States, they are currently in clinical trials and may soon represent a new form of vision correction surgery.

In LASIK and PRK, vision correction is achieved by removing corneal tissue with a laser to reshape the eye. But with corneal inlays or onlays inserted just beneath the surface of the cornea, laser energy some day could be used to sculpt this artificial material instead of the eye itself, and corneal thickness can be preserved.

Corneal inlays and onlays will work much like contact lenses, but with the advantage of never needing removal or ongoing care. And they differ from currently available intraocular lenses, or IOLs, because they are less invasive and aren't placed in the interior of the eye (behind the cornea or iris).

And because corneal inlays and onlays don't require tissue to be removed from the cornea, there may be less risk of ectasia (bulging of the cornea), dry eye and other potential complications of laser vision correction procedures like LASIK and PRK.

The corneal inlay procedure

With corneal inlays, a thin flap is created on the eye's surface with a laser or a microkeratome. In this regard, the procedure is very similar to the first step of LASIK. The inlay is then positioned in the center of the cornea, and the flap is replaced to hold it in place.

The procedure takes less than 15 minutes and can be performed in the eye surgeon's office. Sutures are not required, and only topical anesthesia in the form of eye drops is used.

The corneal onlay procedure

Unlike corneal inlays, where a flap is created to place the inlay within the body of the cornea (called the stroma), corneal onlays are positioned under the cornea's thin outer layer of cells called the epithelium. An instrument is used to create a pocket between the epithelium and the stroma, and the onlay is inserted in this space. The onlay is secure nearly immediately, and within 48 hours, new epithelial cells grow over the surgical wound to seal it completely.

When will these procedures be available in the U.S.?

It's impossible to predict when corneal inlays and onlays will gain FDA approval for use in the United States. Clinical trials have begun for two corneal inlays designed to correct presbyopia, the age-related condition that results in near vision focusing problems.

For more information on corneal inlays and onlays or presbyopia, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Corrective Eye Surgery Basics

Tired of wearing glasses or contact lenses? Today, several surgical methods can correct your eyesight and give you the freedom of seeing well without corrective lenses.

By far, LASIK is currently the most popular vision-correcting or "refractive" surgery available. But there are other options as well. Here's a brief summary of several refractive surgery options and how they compare to LASIK:

PRK

PRK (photorefractive keratectomy) was the first laser vision correction procedure approved in the United States, receiving FDA approval in 1995. It soon became a popular alternative to radial keratotomy (RK), which was the only viable surgical treatment for nearsightedness available at the time. PRK promised to reduce or eliminate many of the complications of RK, including fluctuating vision, glare, halos around lights, infection, unpredictable outcomes, decreased visual acuity and regression (return of nearsightedness).    

Like LASIK, PRK uses an excimer laser to remove corneal tissue to reshape the eye and correct vision. But with PRK, the laser treatment is applied directly to the surface of cornea, rather than under a flap of corneal tissue as in LASIK. Visual outcomes after PRK are comparable to those after LASIK. But the eye is uncomfortable for a couple of weeks after PRK, until the thin outer protective layer of the cornea (the epithelium) grows back. Also, vision can be quite blurred for a week or two after PRK until the eye heals.

The number of PRK procedures declined sharply when LASIK was introduced, because there is usually little or no discomfort after LASIK and vision recovers faster. However, PRK has made a comeback in recent years due to more effective pain management techniques and because it poses less risk of certain complications.

LASIK

LASIK (laser-assisted in situ keratomileusis) is like PRK, except that a thin, hinged flap is made on the cornea prior to the laser treatment. This flap is lifted and folded back, and laser energy is applied to the underlying corneal tissue to reshape the eye. Then the flap is replaced, acting like a natural bandage. LASIK's main advantage over PRK is that there is little or no discomfort immediately after the procedure, and vision is usually clear within hours rather than days.

LASEK

LASEK (laser-assisted sub-epithelial keratomileusis) is a modification of LASIK in which the corneal flap is thinner, containing only epithelial cells. The delicate epithelium is removed by loosening it from the underlying cornea with an alcohol solution. It's then pushed to the side and the laser treatment is applied. The epithelial "flap" is then replaced and covered with a bandage contact lens until it reattaches to the underlying cornea. In most cases, there is less post-operative discomfort with LASEK compared to PRK, and vision recovery may be faster. LASEK is sometimes preferred over LASIK in cases when the patient's cornea is judged to be too thin for a safe LASIK procedure.

Epi-LASIK

Epi-LASIK is very much like LASEK, except a special cutting tool is used to separate the epithelium from the underlying cornea prior to the laser treatment. This eliminates the possibility of an adverse reaction to alcohol placed on the eye and may speed healing after surgery, compared to LASEK. Like LASEK, epi-LASIK is sometimes preferred over LASIK if there are concerns about corneal thickness.
 

IntraLASIK, iLASIK

IntraLASIK and iLASIK are terms sometimes used to describe a LASIK procedure when the corneal flap is created with an IntraLase brand femtosecond laser instead of a bladed instrument (called a microkeratome) for a blade-free, all-laser surgery. All-laser LASIK eliminates the risk of certain complications that can occur when the flap is created with a microkeratome.
 

Wavefront LASIK or PRK

Wavefront (or "custom") LASIK or PRK means the laser treatment is determined by a computerized mapping of the power of your eye called wavefront analysis. Wavefront-guided procedures are more precise than ablations determined by using only an eyeglasses prescription, and they can correct subtle optical imperfections called "higher-order aberrations" that regular ablations can't treat. Several studies show wavefront-guided ablations provide sharper vision than conventional (non-wavefront) LASIK or PRK, and may reduce the risk of nighttime glare and halos.

CK

CK (conductive keratoplasty) is a non-laser refractive surgery that uses a hand-held instrument to deliver low-heat radio waves to a number of spots in the peripheral cornea. This causes the corneal tissue to shrink in these areas, which increases the curvature of the cornea, thereby correcting mild amounts of farsightedness or restoring usable near vision to people over 40 who have presbyopia.

CK for presbyopia is called NearVision CK, and it can be used to correct presbyopia for people who previously had LASIK surgery.

Phakic IOLs

Phakic IOLs (intraocular lenses) are small lenses inserted inside the eye to correct vision problems. The lenses can be place in front of or behind the pupil. "Phakic" refers to the fact that the eye's natural lens remains in the eye during the procedure.

Phakic IOL implantation can correct higher amounts of nearsightedness than LASIK. But because it's an internal eye procedure, there are more risks. Cost of the procedure is also significantly higher.

Refractive Lens Exchange

Refractive Lens Exchange (or RLE) is another non-laser, internal eye procedure. RLE is much like cataract surgery. But instead of removing the eye's natural lens that has grown cloudy, the surgeon removes a clear natural lens and replaces it with an artificial lens of a different shape, usually to reduce or eliminate high amounts of farsightedness. RLE has a higher risk of complications and is more expensive than LASIK. Also, removing the natural lens of a young patient will eliminate near focusing ability, which means reading glasses are required. For these reasons, RLE typically is used only in cases of severe vision correction needs.

Cataract Surgery

Yes, even cataract surgery can be considered a refractive procedure. New lens implants can partially restore a person's near vision in addition to correcting nearsightedness and farsightedness. These lenses, called multifocal IOLs or accommodating IOLs, currently are being used by many cataract surgeons, with promising results.

While Medicare and health insurance will cover basic costs of cataract surgery, you can elect to pay out-of-pocket for the extra costs of these more modern lenses that potentially can restore a full range of vision.

Which procedure is right for you?

If you are interested in LASIK or other vision correction surgery, call our office for a comprehensive eye exam and consultation. We will be happy to discuss whether you are a good candidate for refractive surgery and which procedure may be best for you. We can also recommend an experienced refractive surgeon if you choose to proceed with surgery.

New lens implants developed for cataract surgery can partially restore a person's near vision in addition to correcting nearsightedness and farsightedness. These lenses, called multifocal IOLs or accommodating IOLs, currently are being used by many cataract surgeons, with promising results.

For more information on refractive eye surgery or cataract surgery, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

LASIK

LASIK, short for laser-assisted in situ keratomileusis, is the most popular refractive surgery available today. Each year, more than one million LASIK procedures are performed in the United States.

LASIK has become the premier surgery for vision correction because it's quick and painless, there is little or no discomfort after the procedure and vision recovery is rapid – some patients already see 20/20 the following day.

LASIK can correct nearsightedness, farsightedness and astigmatism. With a special technique called monovision, it can also reduce the need for reading glasses among patients over age 40 who wear bifocals.

Am I a good candidate for LASIK?

To be a good candidate for LASIK, you should be at least 18 years old, have healthy eyes, and have adequate corneal thickness since LASIK corrects your vision by removing tissue from your cornea to reshape your eye.

Chronic dry eye problems, corneal diseases and other abnormalities may disqualify you from having LASIK surgery. In order to know for sure if you are a good candidate, a comprehensive eye exam is required. For your convenience, we are happy to provide LASIK pre-operative exams and consultations at our office. Call us for details.

Important considerations when deciding whether or not to have LASIK are your expectations and your ability to accept a less-than-perfect outcome. LASIK can reduce your dependence on glasses and almost always gives you the ability to function well without the need for glasses or contact lenses. But there are no guarantees, and LASIK doesn't always create perfect vision. In some cases, your vision after LASIK may be permanently less clear than it was with glasses before the procedure. You have to ask yourself if you're willing to accept the risk of such an outcome before you decide to have LASIK surgery.

Remember: LASIK is an elective procedure, not a required one.

The LASIK procedure

LASIK is an ambulatory procedure. You walk in the surgery center, have the procedure and walk out again. The actual surgery usually takes less than 15 minutes for both eyes, but expect to be at the surgery center for an hour or more.

LASIK is a two-step procedure. In the first step, the surgeon creates a thin, hinged flap of tissue on your cornea with an instrument called a microkeratome or with a laser. This flap is folded back and the second step – the laser reshaping of your eye – begins. After the laser treatment, which usually takes less than a minute, the flap is repositioned and the surgeon moves on to your other eye. 

What is wavefront LASIK?

Wavefront LASIK (also called wavefront-assisted, wavefront-guided or custom LASIK) means the laser treatment (or "ablation") is determined by a computerized mapping of the power of your eye called wavefront analysis. Wavefront-guided procedures are more precise than ablations determined by using only an eyeglasses prescription, and they can correct subtle optical imperfections of the eye called "higher-order aberrations" that regular ablations can't treat. Several studies show wavefront-guided ablations provide sharper vision than conventional, non-wavefront LASIK and may reduce the risk of nighttime glare and halos.

After LASIK surgery

After the procedure, your surgeon or an assistant will apply medicated eye drops and clear protective shields over your eyes. You can open your eyes and see well enough to walk without glasses, but you must have someone drive you home.

You will be expected to use medicated eye drops several times a day for a week or so to protect your eyes from infection and help them heal properly. You will also be told to use artificial tears frequently to keep your eyes moist and comfortable.

You should rest and not use your eyes much when you get home from surgery that day. You may also be more comfortable if the lights in your house are dimmed.

The following day, you should be seeing well enough to drive and can resume most activities. Be careful, however, not to rub your eyes until your eye doctor tells you it is safe to do so.

Usually, you will be asked to return to the surgery center the following day so your surgeon or another eye doctor at the center can check your vision and make sure your eyes appear as they should. At this visit, you typically will be given additional instructions about using eye drops and artificial tears, and you will be able to ask the doctor any questions you have.

From this point forward (and sometimes for this "day one" visit as well), your post-operative care may be performed by an eye doctor other than your LASIK surgeon. When your post-operative care is provided by a doctor other than your surgeon or another doctor at the surgery center, it's called co-management. We are happy to provide post-operative care for you at our office through a co-management agreement with your surgeon. Call our office for details. 

What if my vision is still blurry after LASIK?

Though most patients see quite clearly in a matter of days after LASIK, it can take several months before your eyes are completely stable. Until then, improvements in your vision can still occur. But if several months pass and your vision is still blurred, see your LASIK surgeon. Usually a second LASIK surgery (called an enhancement) can sharpen your eyesight further.

If for some reason an enhancement is not indicated or desired, eyeglasses or contact lenses may help. We will be happy to examine your eyes and discuss the different options with you.

Eyewear after LASIK

Keep in mind that, even if your vision seems perfect after LASIK, you still need eyewear.

When outdoors, it's important to protect your eyes from the sun's harmful rays with sunglasses that provide 100% UV protection. If you play sports when wearing sunglasses, make sure the lenses have polycarbonate lenses for extra protection. And any time you're working with power tools or doing anything else when an eye injury is possible, you should wear safety glasses with polycarbonate lenses.

If you're over 40 (or soon will be), it's likely you'll need reading glasses after LASIK. Also, many LASIK patients can benefit from a pair of prescription eyeglasses for night driving. Though these lenses may have only a mild prescription, they often can make your vision sharper for added safety and comfort.

Eye care after LASIK

And don't forget to continue to have routine eye exams after LASIK. Even if your vision is perfect, you still need to have your eyes checked for glaucoma and other potential problems on a regular basis. Routine exams also help you make sure your vision stays stable after LASIK.

We are happy to serve all your eyewear and eye care needs after your LASIK surgery.

For more information on LASIK eye surgery, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

LASIK Criteria for Success

Laser eye surgery isn't for everyone. Here are six guidelines to help you decide if LASIK is right for you:

  • Are your eyes healthy? If you have any condition that can affect how your eyes respond to surgery or heal afterwards, wait until that condition is resolved. Examples include chronic dry eyes, conjunctivitis ("pink eye") and any eye injury. Some conditions, such as cataracts, keratoconus and uncontrolled glaucoma, may disqualify you completely.
     
  • Are you an adult? You need to be at least 18 years of age to have LASIK. (Younger patients can sometimes be treated as an exception. Discuss this with your surgeon.)
     
  • Is your vision stable? Many teenagers and young adults experience changes in their prescription for eyeglasses or contact lenses from year-to-year, especially if they are nearsighted. Make sure your prescription is stable for a 12-month period before having LASIK. If it's not and you proceed anyway, you may need another surgery next year!
     
  • Are you pregnant?Hormonal changes during pregnancy can cause swelling in your corneas, changing your vision. Dry eyes are also common when you're pregnant. Also, eye medications (antibiotics and steroids) used during and after LASIK may be risky for your baby, whether unborn or nursing. Wait a few months after your baby is born before having LASIK.

 

  • Certain systemic and autoimmune diseases may be disqualifiers, too. Examples include rheumatoid arthritis, type 1 diabetes, HIV and AIDS. Basically, if your body has any trouble with healing, your corneas may not heal properly after LASIK. Opinions vary among surgeons as to which diseases are automatic disqualifiers and which ones might pose acceptable risks in certain cases.
     
  • Your prescription must be within certain limits. For example, very high amounts of myopia, which would require removal of too much corneal tissue, may preclude LASIK or make another type of refractive surgery a better option. For example, many surgeons feel a phakic IOL procedure provides a better visual outcome and poses less risk than LASIK for nearsighted prescriptions higher than -9.00 diopters.

To find out if you're a good candidate for LASIK, visit our office for a comprehensive eye exam and refractive surgery consultation.

For more information on LASIK surgery, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

LASIK Risks and Complications

If you are considering LASIK and worried that something could go wrong, you might take comfort in knowing that it's very rare for complications from this procedure to cause permanent, significant vision loss. Also, many complications can be resolved through laser re-treatment.

Selecting the right eye surgeon probably is the single most important step you can take to decrease any risks associated with LASIK. An experienced, reputable surgeon will make sure you are a good candidate for LASIK before a procedure is recommended. And if problems develop during or after the procedure, the surgeon should work closely with you to resolve them.

How common are LASIK complications?

Public confidence in the LASIK procedure has grown in recent years because of a solid success rate involving millions of successful procedures in the United States. With increasingly sophisticated technology used for the procedure, most LASIK outcomes these days are very favorable.

The U.S. military also has adopted the use of refractive surgery including LASIK to decrease reliance of troops on prescription eyewear. In a study of more than 16,000 U.S. Army personnel who underwent refractive surgery from 2000 through 2003, 86 percent achieved 20/20 or better uncorrected vision and 98 percent achieved 20/40 or better (the legal requirement for driving without glasses in most states).

"Reports of night vision difficulties, LASIK flap dislocation, and dry eye are infrequent, and do not seem to have a significant negative impact on military operations or individual readiness," researchers who studied these outcomes concluded in the February 2005 issue of Ophthalmology.

LASIK complication rates

Experienced LASIK surgeons report that serious complication rates can be held well below 1 percent if surgical candidates are screened and carefully selected. You may be eliminated as a candidate, for example, if you are pregnant or have certain conditions such as diabetes that may affect how well your eyes heal after LASIK. Discuss any health conditions you have with your eye doctor during your LASIK consultation or pre-operative exam.

Large pupil sizes also might be risk factors for LASIK complications, because pupils in dark conditions could expand beyond the area of the eye that was treated. Again, make sure you discuss any concerns about these or other matters with your eye surgeon.

Other considerations about LASIK risks

While the great majority of LASIK outcomes are favorable, there is still that fraction of less than 1 percent of people who experience sometimes serious and ongoing vision problems following LASIK. No surgical procedure is ever risk-free.

Some LASIK patients with excellent vision based on eye chart testing still can have bothersome side effects. For example, it's possible a patient may see 20/20 or better with uncorrected vision after LASIK but still experience glare or halos around lights at night.

When you sign the LASIK consent form prior to surgery, you should do so with a full understanding that, even in the best of circumstances, there is a slight chance something unintended could occur. Even so, most – but not all – problems eventually can be resolved.

Common LASIK complications

When LASIK complications occur, they are sometimes associated with the hinged flap that's created in the cornea (the clear front covering of the eye) in the first step of the LASIK procedure. This flap lifted prior to re-shaping the underlying cornea with a laser, and is then replaced to form a natural bandage.

If the LASIK flap is not made correctly, it may fail to adhere correctly to the eye's surface. The flap also might be cut too thinly or thickly. After the flap is placed back on the eye's surface, it might begin to wrinkle. These types of flap complications can lead to an irregularly-shaped eye surface.

Studies indicate that flap complications occur in from 0.3 percent to 5.7 percent of LASIK procedures, according to the April 2006 issue of American Journal of Ophthalmology. But inexperienced surgeons definitely contribute to the higher rates of flap complications. Again, remember that you can improve your odds of avoiding LASIK risks by selecting a reputable, experienced eye surgeon.

Some problems associated with LASIK flap complications include:

Irregular astigmatism can result from a less than smooth corneal surface. Irregular astigmatism also can occur from laser correction that is not centered properly on the eye. Resulting symptoms may include double vision or "ghost images." In these cases, the eye may need re-treatment (also called an "enhancement").

Diffuse Lamellar Keratitis (DLK), also nicknamed "Sands of the Sahara," is inflammation that can occur under the LASIK flap after surgery. In rare cases, DLK leads to corneal scarring. Potentially permanent vision loss can occur without prompt treatment with therapies such as antibiotics and topical steroids. The flap also might need to be lifted and rinsed to remove inflammatory cells and prevent tissue damage.

Ectasia (or keratectasia) is bulging of the cornea that can occur from a flap being cut too deeply, when too much tissue is removed from the cornea during LASIK, or when the cornea was initially weakened as evidenced from cornea topography mapping prior to LASIK. Resulting distorted vision likely cannot be corrected with laser enhancement, and rigid contact lenses or corneal implants (Intacs) may be prescribed to hold the cornea in place.

Other, more commonly reported LASIK complications include:

  • Dry Eye: Almost half of all patients report problems with dry eye in the first six months following LASIK, according to the April 2006 issue of American Journal of Ophthalmology. These complaints appear related to reduced sensitivity of the eye's surface immediately following the procedure. If you have this problem, temporary remedies such as artificial tears or prescription dry eye medication may be needed along with oral flaxseed oil capsules. After about six months to a year, however, most of these types of complaints disappear when healing of the eye is complete. People who already have severe dry eye usually are eliminated as LASIK candidates.
     
  • Significant Undercorrection, Overcorrection, or Regression: An overcorrection or undercorrection of your vision problem means your vision may remain slightly blurred from residual nearsightedness, farsightedness or astigmatism. Regression is when your eyesight is optimal at first after LASIK, but then begins to deteriorate over time (due to a return of some nearsightedness, for example). These problems can usually be corrected with an enhancement LASIK procedure.
     
  • Eye Infection or Irritation: In some rare cases, you may develop an eye infection, inflammation, or irritation that requires treatment with eye drops containing antibiotics or anti-inflammatory medication such as steroids.

Vision changes unrelated to LASIK

If you have LASIK in your 20s or 30s, be aware that your reading vision will change as you get older. This has nothing to do with your LASIK surgery – it's caused by a normal age-related loss of focusing ability called presbyopia. Because of presbyopia, most LASIK patients (like anyone else who sees well without glasses in younger years) will need reading glasses after age 40.

For more information on LASIK eye surgery, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Surgery for Presbyopia

Presbyopia is the normal age-related loss of near focusing ability. If you're over 40 and have to move the newspaper farther away to read it, you are beginning to experience presbyopia.

Even if you've had your vision corrected with LASIK surgery in your 20s or 30s, you'll still experience reading vision problems from presbyopia in your 40s, 50s and beyond.

When the time comes, most people deal with presbyopia by wearing reading glasses or eyeglasses with bifocal or progressive ("no-line bifocal") lenses.  But if you want greater freedom from glasses after age 40, there are surgical options for the correction of presbyopia as well:

Monovision LASIK

Monovision is a presbyopia-correcting technique where your eye doctor prescribes lens powers for one eye to see clearly across the room (leaving it slightly blurred up close) and the other eye to see well up close (making it slightly blurry far away). The two eyes still work together as a team, but one eye does more of the work for your distance vision, and the other supplies more of your near vision.

Though it may sound odd, monovision contact lens fittings have been done for years, and most presbyopes who try monovision adapt to it quite well. Reading glasses may still be needed for very small print or sustained reading, but a person can usually be glasses-free most of their day with monovision.

Recently, LASIK surgeons have begun using this monovision technique as well, and success rates should be as good as or better than monovision with contact lenses. Before you commit to monovision permanently with LASIK surgery, however, try it with contact lenses first. If it works for you with contacts, you can then proceed with monovision LASIK with greater confidence (provided you meet the other criteria of a good candidate for LASIK).

Monovision CK (NearVision CK)

CK (conductive keratoplasty) uses a hand-held probe to deliver controlled radio-frequency energy to specific spots in the periphery of the cornea. This shrinks the corneal tissue in these spots and steepens the central cornea, making the eye more nearsighted.

NearVision CK, the version of CK for presbyopia, uses a monovision approach and is performed on one eye only. NearVision CK is less invasive and less expensive than LASIK, and is a good option for someone who only needs reading glasses – that is, someone who is presbyopic but has no nearsightedness, farsightedness or astigmatism.

The effects of CK tend to fade over time. So at some point, additional procedures may be needed. Like with monovision LASIK, it's a good idea to first try monovision with contact lenses to make sure you're comfortable with it before proceeding with NearVision CK surgery.

Multifocal IOLs and RLE

Multifocal intraocular lenses (IOLs) are a variation of the lens implants that have been used for years in cataract surgery. But instead of having just one lens power to correct nearsightedness or farsightedness, these new lenses have multiple powers to correct vision at all distances.

Multifocal IOLs can be used in cataract surgery to replace the eye's cloudy natural lens, or they can be used to replace a clear natural lens that has just lost its ability to change shape for reading due to presbyopia. This second procedure is called refractive lens exchange (RLE).

Because both cataract surgery and RLE are intraocular procedures, they have more associated risks than less invasive procedures like LASIK and CK. Possible complications of IOL procedures include glaucoma and retinal detachment.

Accommodating IOL (Crystalens®)

Another type of IOL that's used in the same manner as a multifocal IOL is the "accommodating" IOL. This intraocular lens has just one lens power, but the central optical portion of the device is supported by structures called haptics that enable the lens to move slightly forward and backward inside the eye in response to focusing effort. In this manner, an accommodating IOL restores some of the eye's ability to change focus on demand.

The accommodating IOL is approved for use in the United States as part of cataract surgery, and has the same risks as other intraocular lens surgeries.

Multifocal LASIK (PresbyLASIK)

PresbyLASIK is a multifocal variation of LASIK that is available in Europe and Canada, but is not yet FDA approved in the U.S. In PresbyLASIK, the excimer laser creates concentric rings of different powers on the cornea (much like the alternating powers on a multifocal soft contact lens) to provide good vision at all distances.

Studies show presbyopic patients are quite pleased with the overall performance of PresbyLASIK, though many of them still need to wear eyeglasses for some activities. Also, though near vision after PresbyLASIK is usually good in bright light, reading glasses are usually required in low-light situations.

Corneal Inlays

Corneal inlays are another surgical solution for presbyopia in development and not yet FDA-approved for use in the United States. In this procedure, a small circular device is implanted within the cornea to improve near vision. Corneal inlays will work much like multifocal contact lenses, but with the advantage of never needing removal or ongoing care.

For more information on presbyopia and presbyopia surgery, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Low Vision

How To Cope With Low Vision

Low vision is the term used to describe reduced eyesight – either blurred vision (usually 20/70 or worse) or an incomplete field of view – that cannot be fully corrected with eyeglasses, contact lenses or eye surgery. The primary causes of low vision are eye diseases, such as macular degeneration, glaucoma and diabetic retinopathy. But low vision also can be inherited or caused by an eye or brain injury.

A person with low vision is not blind: they have some useful sight. But the degree of their visual impairment can make daily tasks, such as reading and driving, difficult or impossible.

Though children as well as adults can be visually impaired, low vision is mostly a problem that afflicts seniors. Vision loss after a lifetime of good eyesight can be very traumatic, leading to frustration and depression.

Many people who develop eye problems that cause low vision lose their jobs. According to Lighthouse International, among visually impaired Americans of ages 21 to 64, only 43.7% are employed. Among normally-sighted people in this age group, 80% are employed.

Not being able to drive safely, read quickly, or easily see images on a television or computer screen can cause people with low vision to feel shut off from the world. They may be unable to get around town independently, earn a living or even shop for food and other necessities. Some visually impaired people become completely dependent on friends and relatives, while others suffer alone.

Thankfully, in many cases, people with impaired vision can be helped by low vision devices, which include eyeglass-mounted magnifiers, handheld magnifiers and telescopes, and stand-alone magnifiers. There are many ingenious low vision devices and strategies that can help visually-impaired individuals get the most out of their remaining sight and, in many cases, continue to live independently.

If you have hazy or blurred vision, light sensitivity, loss of peripheral vision, night blindness, a need for more light than before, unusual floaters or spots, or difficulty reading — your first step is to see an eyecare professional for a complete exam.

These could be the first signs of a serious eye disease such as macular degeneration, glaucoma, or retinitis pigmentosa. Or, they could mean you are developing a cataract that needs removal. Whatever the case, it's wise to take action before further vision loss occurs.

If your eye doctor finds you have a vision loss that cannot be corrected with eyewear, medical treatment or surgery, they can refer you to a low vision specialist. Usually an optometrist, a low vision specialist can evaluate the degree and type of vision loss you have, prescribe appropriate low vision aids, and help you learn how to use them.

The low vision specialist can also recommend non-optical adaptive devices, such as large-print books, audio tapes, special light fixtures and signature guides for signing checks and documents. If necessary, your eye doctor or low vision specialist can also refer you to a counselor to help you cope with your loss of vision.

For more information on low vision, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Low Vision Aids for Computer Users

In general, visually-impaired people can use the same low vision aids for viewing a computer screen and reading e-mail as they do for other reading activities. In addition, special software has been developed to increase the size of print and images on computer screens and convert printed information into audible messages that are "read" by a synthetic voice.

These innovative low vision devices let partially-sighted people do the same computer-related tasks as fully-sighted people – such as word-processing, creating and using spreadsheets and viewing Web pages online.

Increasing print and image sizes

Most computer operating systems and Internet browsers allow you to increase the size of Web pages and text on your computer screen to make them more visible to partially-sighted users.

Here are a few simple tips for adjusting text size:

  • In browsers such as Microsoft's Internet Explorer, Mozilla's Firefox and Apple's Safari, you can enlarge text on your screen by holding down the Control ("Ctrl") key on your keyboard and tapping the "+" key.
     
  • To return the text to its normal size, tap the "-" key while holding down the Control key.
     
  • You also can hold down the Control or Command key, and then use the wheel on your mouse (see below) to increase or decrease the text size on your screen.
     
  • Still another way to enlarge text on your screen is to use the "Text Size" or "Make Text Larger" command within "View" in the drop-down menu bar that appears at the top of your screen, but only when you use popular software programs such as Microsoft Word and Outlook.

Large-print display software goes the extra step and displays not just larger text, but also icons, mouse pointers and other navigation items at larger sizes.

For better visibility, it's also a good idea to purchase a large LCD display for your desktop computer – a screen that measures at least 20 inches diagonally can be a big help. Another option is to use a screen magnifier placed in front of your display.

Talking computers

People with tunnel vision from glaucoma or central blind spots from macular degeneration may find it difficult and tiring to read an entire computer screen. This is one reason that "talking computers" were invented.

Talking computers are based on optical character recognition (OCR) systems that first scan text in a word processing document or Web page, and then convert the text to sounds. The result is a synthetic voice that reads aloud not only the actual text but also important navigation items such as the cursor location. Voice systems are available from several major software companies.

Your mouse

Some people with low vision, especially if they are good typists, like to use keyboard commands instead of a mouse, because it can be easier to type a keyboard command than to move the cursor to a precise place on the screen with a mouse.

If you would rather use a mouse, choose one that is ergonomically designed for comfort and ease of use. One great innovation is a wheel that is mounted in the center of the mouse and lets you scroll up and down the screen just by moving the wheel with your finger.

A wireless optical mouse is another good option, because your movements aren't limited by the wire leading from the mouse to the computer. If you sometimes experience hand cramps, try using a bigger mouse that lets your hand stay in a more open position, instead of clenched up.

A common source of frustration is a mouse set at a speed that is too fast or too slow. If you're a Windows user and you can't control your mouse because it seems to "zoom" across the screen, you can adjust this by clicking on the Start menu, then Control Panel, then Mouse. There you'll find all kinds of mouse behavior settings, including the pointer speed.

Eliminate display "flicker," enhance contrast

If images on your computer monitor seem to flicker, you can usually eliminate this by adjusting the screen refresh rate, which is how often your monitor redraws the content on the screen. If you use Windows, go to the Start menu, then Control Panel, then Display, then Advanced, then Monitor. Set the refresh rate to 70 Hz (hertz) or higher.

You can eliminate flicker problems altogether by purchasing a liquid crystal display (LCD), which doesn't require images to be "refreshed" like a traditional cathode ray tube (CRT) monitor. For this reason, LCD screens typically cause less eyestrain. For the best screen visibility for someone with low vision, choose an LCD display with a high contrast ratio. Salespeople at your local computer store can help you identify these models.

For more information on low vision aids, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Problems and Diseases

Amblyopia (Lazy Eye)

Amblyopia, also known as "lazy eye," is the lack of normal visual development in an eye, despite the eye being healthy. If left untreated, it can cause legal blindness in the affected eye. About 2% to 3% of the population is amblyopic.

Amblyopia signs and symptoms

Amblyopia generally starts at birth or during early childhood. Its symptoms often are noted by parents, caregivers or health-care professionals. If a child squints or completely closes one eye to see, he or she may have amblyopia. Other signs include overall poor visual acuity, eyestrain and headaches.

What causes amblyopia?

The most common cause of amblyopia is strabismus (intermittent or constant misalignment of the eyes).  Another common cause is a significant difference in the refractive errors (nearsightedness, farsightedness and/or astigmatism) in the two eyes. It's important to correct amblyopia as early as possible, before the brain ignores vision in the affected eye.

Treatment of amblyopia

Amblyopic children can be treated with vision therapy (which often includes patching one eye), atropine eye drops, the correct prescription for nearsightedness or farsightedness or surgery.

Vision therapy exercises the eyes and helps both eyes work as a team. Vision therapy for someone with amblyopia forces the brain to use the amblyopic eye, thus restoring vision.

Sometimes the eye doctor or vision therapist will place a patch over the stronger eye to force the weaker eye to be used more. Patching may be required for several hours each day or even all day long, and may continue for weeks or months. If you have a lot of trouble with your child taking the patch off, you might consider a prosthetic contact lens that is specially designed to block vision in one eye but is colored to closely match the other eye.

In some children, atropine eye drops have been used to treat amblyopia instead of patching. One drop is placed in your child's good eye each day (your eye doctor will instruct you). Atropine blurs vision in the good eye, which forces your child to use the eye with amblyopia more, to strengthen it. One advantage of this method of treatment is that it doesn't require your constant vigilance to make sure your child wears an eye patch.

If your child has become amblyopic due to a strong uncorrected refractive error or a large difference between the refractive errors of their eyes, amblyopia can sometimes simply be treated by wearing eyeglasses or contact lenses full-time. In some cases, patching may be recommended along with the new glasses or contact lenses.

In cases when the amblyopia is caused by a large eye turn, strabismus surgery is usually required to straighten the eyes. The surgery corrects the muscle problem that causes strabismus so the eyes can focus together and see properly.

Amblyopia will not go away on its own, and untreated amblyopia can lead to permanent visual problems and poor depth perception. If your child has amblyopia and the stronger eye develops disease or is injured later in life, the result will be poor vision through the amblyopic eye. To prevent this and to give your child the best vision possible, amblyopia should be treated early on.

If amblyopia is detected and aggressively treated before the age of 8 or 9, in many cases the weak eye will be able to develop 20/20 vision.

For more information on amblyopia and strabismus, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Astigmatism

Astigmatism is one of the most common vision problems, but most people don't know what it is.

Many people are relieved to learn that astigmatism is not an eye disease. Like nearsightedness and farsightedness, astigmatism is a type of refractive error – a condition related to the shape and size of the eye that causes blurred vision.

In addition to blurred vision, uncorrected astigmatism can cause headaches, eyestrain and make objects at all distances appear distorted.

Astigmatism signs and symptoms

If you have only a small amount of astigmatism, you may not notice it at all, or you may have only mildly blurred or distorted vision. But even small amounts of uncorrected astigmatism can cause headaches, fatigue and eyestrain over time.

Astigmatism usually develops in childhood. A study at the Ohio State University School of Optometry found that more than 28% of schoolchildren have astigmatism.

Children may be even more unaware of the condition than adults, and they may also be less likely to complain of blurred or distorted vision. But astigmatism can cause problems that interfere with learning, so it's important to have your child's eyes examined at regular intervals during their school years.

What causes astigmatism?

Usually, astigmatism is caused by an irregular-shaped cornea, the clear front surface of the eye. In astigmatism, the cornea isn't perfectly round, but instead is more football- or egg-shaped.

In some cases, astigmatism may be caused by an irregular-shaped lens inside the eye.

In most astigmatic eyes, the irregular shape of the cornea or lens causes light rays to form two distorted images in the back of the eye, rather than a single clear one. This is because, like a football, an astigmatic eye has a steeper curve and a flatter one.

How is astigmatism treated?

In most cases, astigmatism can be fully corrected with eyeglasses or contact lenses.

Rigid gas permeable (RGP or GP) contact lenses often provide the best correction for astigmatism. But special soft contact lenses for astigmatism, called toric soft lenses, are also available.

Hybrid contact lenses are another option. These lenses have a GP center and a soft periphery to provide the clarity of gas permeable lenses and wearing comfort that is comparable to soft lenses.

And, depending on the type and severity of your astigmatism, you may also be able to have it corrected with LASIK or other types of refractive surgery.

For more information on astigmatism or toric contact lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Blepharitis

Blepharitis is inflammation of the eyelids, occurring particularly at the lid margins. It's a common disorder and may be associated with a low-grade bacterial infection or a generalized skin condition.

Blepharitis occurs in two forms: anterior blepharitis and posterior blepharitis.

Anterior blepharitis affects the front of the eyelids, usually near the eyelashes. The two most common causes of anterior blepharitis are bacteria and a skin disorder called seborrheic dermatitis, which causes itchy, flaky red skin.

Posterior blepharitis affects the inner surface of the eyelid that comes in contact with the eye. It is usually caused by problems with the oil (meibomian) glands in the lid margin. Posterior blepharitis is more common than the anterior variety, and often affects people with a rosacea skin type.

Blepharitis signs and symptoms

Regardless of which type of blepharitis you have, you will probably have such symptoms as eye irritation, burning, tearing, foreign body sensation, crusty debris (in the lashes, in the corner of the eyes or on the lids), dryness and red eyelid margins.

It's important to see an eye doctor and get treatment. If your blepharitis is bacterial, possible long-term effects are thickened lid margins, dilated and visible capillaries, misdirected eyelashes, loss of eyelashes and a loss of the normal position of the eyelid margin against the eye. Blepharitis can also lead to styes and infections or erosions of the cornea.

Blepharitis treatments

Blepharitis can be difficult to manage because it tends to recur. Treatment depends on the type of blepharitis you have. It may include applying warm compresses to the eyelids, cleaning your eyelids frequently, using an antibiotic and/or massaging the lids to help express oil from the meibomian glands.

If your blepharitis makes your eyes feel dry, artificial tears or lubricating ointments may also be recommended. In some cases, anti-bacterial or steroid eye drops or ointments may be prescribed.

Always wash your hands before and after touching your eyelids when treating blepharitis. Your eye doctor will provide instructions on the products and techniques to use to relieve symptoms and get your blepharitis under control. Thereafter, a daily regimen of lid hygiene is helpful in preventing recurrences of blepharitis.

There is some evidence to suggest that taking a daily flaxseed oil supplement that contains omega-3 fatty acids may help prevent or reduce the severity of posterior blepharitis. Be sure to discuss any supplement use with your doctor.

Because blepharitis tends to be chronic, expect to keep up therapy for a prolonged period of time to keep it at bay. If you normally wear contact lenses, you may need to discontinue wearing them during the treatment period and even beyond. Sometimes, changing from soft contact lenses to rigid gas permeable (GP) contacts can be helpful, since GP lenses are less likely to accumulate lens deposits. In other cases, contact lens discomfort caused by blepharitis can be relieved by replacing soft contact lenses more frequently or changing to one-day disposable lenses.

For more information on blepharitis or GP contact lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

CMV Retinitis

Cytomegalovirus (CMV) retinitis is a sight-threatening disease associated with late-stage AIDS. In the past, about 25% of active AIDS (Acquired Immunodeficiency Syndrome) patients developed CMV retinitis. However, this figure appears to be dropping thanks to a potent combination of drugs that help restore the function of the immune system.

CMV retinitis signs and symptoms

When the cytomegalovirus invades the retina, it begins to compromise the light-sensitive receptors that enable us to see. This does not cause any pain, but you may see floaters or small specks and experience decreased visual acuity, distorted vision or decreased peripheral vision. Light flashes and sudden loss of vision can also occur. The disease usually starts in one eye but often involves both eyes.

If left untreated, CMV retinitis can cause retinal detachment and blindness in less than six months.

AIDS patients sometimes also experience changes to the retina and optic nerve without clear signs of CMV retinitis.

What causes CMV retinitis?

CMV retinitis is caused by the cytomegalovirus, which is a very common virus. About 80% of adults harbor antibodies to CMV, which indicates their bodies have successfully fought it off. The difference for people who have AIDS is that their weakened or non-functioning immune system cannot stave off this virus. Other people with a weakened or suppressed immune system, such as those undergoing chemotherapy or a bone marrow transplant, are also at risk of CMV retinitis.

How is CMV retinitis treated?

If you have active AIDS and are experiencing visual symptoms, you should see a retina specialist immediately. A person newly-diagnosed with CMV retinitis can expect to visit the specialist every two to four weeks.

Once the disease is controlled, the retina specialist may recommend follow-up visits with your regular eye doctor every three to six months.

Drugs for CMV retinitis. Anti-viral drugs commonly used to treat CMV retinitis are ganciclovir (Cytovene), foscarnet (Foscavir) and cidofovir (Vistide). These medications can slow down the progression of CMV, but they can't cure it. These potent anti-viral drugs can also cause unpleasant or serious side effects.

Ganciclovir is available in a pill, used following two weeks of intravenous infusion, and also in an implant called Vitrasert. The implant releases medication directly into the eye, so it doesn't cause the side effects experienced with intravenous infusion or with the pill.

Drugs for HIV. The biggest breakthrough in AIDS treatment is highly active antiretroviral therapy (HAART), a combination of drugs that suppress the human immunodeficiency virus (HIV), also known as the AIDS virus. HAART allows your immune system to recover and fight off infections like CMV retinitis.

AIDS is a serious global health problem. If you have AIDS, are HIV positive or have a compromised immune system from other causes, see your eye doctor frequently to rule out CMV retinitis and to discuss the latest treatment options if a CMV-related eye problem is detected.

For more information on the retina and associated problems, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Cataracts

A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away.

The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and allows light to pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

Most cataracts occur gradually as we age and don't become bothersome until after age 55. However, cataracts can also be present at birth (congenital cataracts) or occur at any age as the result of an injury to the eye (traumatic cataracts). Cataracts can also be caused by diseases such as diabetes or can occur as the result of long-term use of certain medications, such as steroids.

Cataract signs and symptoms

A cataract starts out small, and at first has little effect on your vision. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass or viewing an impressionist painting. However, as cataracts worsen, you are likely to notice some or all of these problems:

        Blurred vision that cannot be corrected with a change in your glasses prescription.

        Ghost images or double vision in one or both eyes.

        Glare from sunlight and artificial light, including oncoming headlights when driving at night.

        Colors appear faded and less vibrant.

What causes cataracts?

No one knows for sure why the eye's lens changes as we age, forming cataracts. Researchers are gradually identifying factors that may cause cataracts, and gathering information that may help to prevent them.

Many studies suggest that exposure to ultraviolet light is associated with cataract development, so eye care practitioners recommend wearing sunglasses and a wide-brimmed hat to lessen your exposure. Other types of radiation may also be causes. For example, a study conducted in Iceland suggests that airline pilots have a higher risk of developing a nuclear cataract than non-pilots, and that the cause may be exposure to cosmic radiation. A similar theory suggests that astronauts, too, are at greater risk of cataracts due to their higher exposure to cosmic radiation.

Other studies suggest people with diabetes are at risk for developing a cataract. The same goes for users of steroids, diuretics and major tranquilizers, but more studies are needed to distinguish the effect of the disease from the consequences of the drugs themselves.

Some eyecare practitioners believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C and E, may forestall cataract development. Meanwhile, eating a lot of salt may increase your risk.

Other risk factors for cataracts include cigarette smoke, air pollution and heavy alcohol consumption.

Cataract treatment

When symptoms of cataracts begin to appear, you may be able to improve your vision for a while using new glasses, stronger bifocals and greater light when reading. But when these remedies fail to provide enough benefit, it's time for cataract surgery.

Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with nearly 3 million cataract surgeries done each year. More than 90% of people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40, and sight-threatening complications are relatively rare.

During surgery, the surgeon will remove your clouded lens and replace it with a clear, plastic intraocular lens (IOL). New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more helpful to patients. Presbyopia-correcting IOLs not only improve your distance vision, but can decrease your reliance on reading glasses as well.

If you need cataracts removed from both eyes, surgery usually will be done on only one eye at a time. An uncomplicated surgical procedure lasts only about 10 minutes. However, you may be in the outpatient facility for 90 minutes or longer because extra time will be needed for preparation and recovery.

Presbyopia-correcting IOLs: Frequently asked questions

If you need cataract surgery, you may have the option of paying extra for new presbyopia-correcting IOLs that potentially can restore a full range of vision without eyeglasses.

Presbyopia-correcting IOLs are a relatively new option, so you may have questions such as:

1. What are presbyopia-correcting IOLs?

Presbyopia-correcting intraocular lenses (IOLs) are lens implants that can correct both distance and near vision, giving you greater freedom from glasses after cataract surgery than standard IOLs. They are available in two forms: multifocal lenses and accommodating lenses. Multifocal lenses are similar to multifocal contact lenses – they contain more than one lens power for different viewing distances. Accommodating IOLs have just one lens power, but the lens is mounted on flexible "legs" that allow the lens to move forward or backward within your eye in response to focusing effort to enable you to see clearly at a range of distances.

 2. Aren't presbyopia-correcting IOLs a lot more expensive? How much extra do I have to pay?

Yes, presbyopia-correcting IOLs are more expensive than standard IOLs. Costs vary, depending on the lens used, but you can expect to pay up to $2,500 extra per eye. This added amount is usually not covered by Medicare or other health insurance policies, so it would be an "out-of-pocket" expense if you choose this advanced type of IOL for your cataract surgery.

3. Why won't Medicare or health insurance cover the full cost of presbyopia-correcting IOLs?

A multifocal or accommodating IOL is not considered medically necessary. In other words, Medicare or your insurance will pay only the cost of a basic IOL and accompanying cataract surgery. Use of a more expensive, presbyopia-correcting lens is considered an elective refractive procedure, a type of luxury, just as LASIK and PRK are refractive procedures that also typically are not covered by health insurance.

4. Can my local cataract surgeon perform presbyopia-correcting surgery?

Not all cataract surgeons use presbyopia-correcting IOLs for cataract surgery. Make sure your eye surgeon has experience with these lenses if you choose a multifocal or accommodating IOL. Studies have shown that surgeon experience is a key factor in successful outcomes, particularly in terms of whether you will need to wear eyeglasses following cataract surgery.

5. Are any problems associated with presbyopia-correcting IOLs?

At a 2007 American Society of Cataract and Refractive Surgery conference, some reports indicated that even experienced cataract surgeons needed to perform enhancements for 13% to 15% of cases involving use of presbyopia-correcting IOLs. Enhancements don't mean that the procedure itself was a failure, because you likely will see just fine with eyeglasses even if your outcome is less than optimal. But it's possible you may need an additional surgical procedure (such as LASIK) to perfect your uncorrected vision after cataract surgery with a presbyopia-correcting IOL. Depending on the arrangement you make with your eye surgeon, you also may need to pay extra for any needed enhancements.

For more information on cataracts and cataract surgery, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Cornea Transplant

A cornea transplant, which replaces damaged tissue on the eye's clear surface, also is referred to as a corneal transplant, keratoplasty, penetrating keratoplasty (PK) or corneal graft.

A cornea transplant replaces central corneal tissue, damaged due to disease or injury, with healthy corneal tissue donated from an eye bank. An unhealthy cornea affects your vision by scattering light and causing blurred or distorted vision. In some cases, a cornea can be so damaged or scarred that a transplant is necessary to restore your functional vision.

Cornea transplants are performed routinely. In fact, of all tissue transplants, the most successful is a corneal transplant. The National Keratoconus Foundation estimates that more than 40,000 cornea transplants are performed in the United States each year.

A new version of corneal transplant, known as Descemet's Stripping Endothelial Keratoplasty (DSEK), also has been introduced as a new surgical method that uses only a very thin portion of the cornea for transplant. In certain cases, this type of procedure may be preferred because it has advantages such as being less likely to create an irregular corneal surface (astigmatism) as a side effect.

Are you a candidate for a cornea transplant?

Your eye doctor may suggest a corneal transplant for reasons varying from diseases to eye injuries, which can include the following:

  • Scarring from infections, such as eye herpes or fungal keratitis.
  • Eye diseases such as keratoconus.
  • Hereditary factors or corneal failure from previous surgeries.
  • Thinning of the cornea and irregular shape (such as with keratoconus).
  • Complications from LASIK.
  • Chemical burns on the cornea or damage from an eye injury.
  • Excessive swelling (edema) on the cornea.

The cornea transplant procedure

Once you and your doctor have decided that a corneal transplant is the best option to restore your functional vision, your name is placed on a list at a local eye bank. The waiting period for a donor eye is generally one to two weeks due to a very sophisticated eye bank system in the U.S. Before donor corneas are released for transplant, tissue is checked for clarity. Also, donor eyes supplying transplant tissue are meticulously screened for presence of diseases such as hepatitis and AIDS or other damage to ensure the health and safety of the recipient.

Typically, corneal transplants are performed on an outpatient basis, meaning that you will not need hospitalization. Local or general anesthesia is used, depending on your health, age, and whether or not you prefer to be asleep during the procedure. With local anesthesia, an injection into the skin around your eye is used to relax muscles that control blinking and movement, and eye drops are used to numb the eye itself.

After the anesthesia has taken effect, the eyelids are held open while your eye surgeon inspects and measures the affected corneal area in order to determine the size of the transplantation. A round, button-shaped section of tissue is then removed from your diseased or injured cornea. A nearly identical-shaped button from the donor tissue is then sutured into place. Finally, the surgeon will place a plastic shield over your eye to protect it from being inadvertently rubbed or bumped. The surgery takes one to two hours.

Cornea graft rejection

Most corneal transplants are successful. The best way to prevent corneal transplant rejection is to recognize the warning signs:

  • Redness
  • Extreme sensitivity to light
  • Decreased vision
  • Pain

Rejection signs may occur as early as one month or as late as five years after surgery. If you have complications with your corneal transplant, your doctor will prescribe medication that can reverse the rejection process. Should your graft fail, the corneal transplant can be repeated, generally with good results. Still, overall rejection rates increase with the number of corneal transplants you have.

Recovering from a cornea transplant

The total recovery time for a corneal transplant may be up to a year or longer. Initially, your vision will be blurry and the site of your corneal transplant may be swollen and slightly thicker than the rest of your cornea. As your vision is restored, you will gradually be able to return to your normal daily activities.

For the first several weeks, heavy exercise and lifting are prohibited. However, you should be able to return to work three to seven days after surgery, depending on your job. Steroid eye drops will be prescribed for several months to help your body accept the new corneal graft. You should keep your eye protected at all times by wearing a shield or a pair of eyeglasses so that nothing inadvertently bumps or enters your eye.

Stitches may be removed from three months to more than a year after surgery, depending on the health of your eye and the rate of healing. Adjustments may be made to the sutures surrounding the new cornea to help reduce the amount of astigmatism resulting from an irregular eye surface.

Your eyesight after a cornea transplant

Your vision will continue to improve up to one year following your surgery. But you will need glasses or contact lenses after surgery, because the curve of the corneal transplant cannot match exactly the curve of your natural cornea. After healing is complete and stitches are removed, it is possible to undergo laser vision correction (LASIK or PRK) to improve your vision and decrease your dependence on glasses or contact lenses.

Rigid gas permeable (RGP or GP) contact lenses often provide the best vision correction for corneal transplant patients due to the irregularity of the cornea after transplant.

Regardless of whether you need corrective eyewear, it's wise to wear safety glasses after a cornea transplant to protect your eyes from injury.

For more information, visit AllAboutVision.com.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Diabetic Retinopathy

If you have diabetes, you probably know that your body can't use or store sugar properly. When your blood sugar gets too high, it can damage the blood vessels in your eyes. This damage may lead to diabetic retinopathy. In fact, the longer someone has diabetes, the more likely they are to have retinopathy (damage to the retina) from the disease.

In its advanced stages, diabetes may lead to new blood vessel growth over the retina. The new blood vessels can break and cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as retinal detachment, and it can lead to blindness if untreated. In addition, abnormal blood vessels can grow on the iris, which can lead to glaucoma. People with diabetes are 25 times more likely to lose vision than those who are not diabetic, according to the American Academy of Ophthalmology.

Signs and symptoms of diabetic retinopathy

Anyone who has diabetes is at risk for developing diabetic retinopathy, but not all diabetics will be affected. In the early stages of diabetes, you may not notice any change in your vision. But by the time you notice vision changes from diabetes, your eyes may already be irreparably damaged by the disease.

That's why routine eye exams are so important. Your eye doctor can detect signs of diabetes in your eyes even before you notice any visual symptoms, and early detection and treatment can prevent vision loss.

Floaters are one symptom of diabetic retinopathy. Sometimes, difficulty reading or doing close work can indicate that fluid is collecting in the macula, the most light-sensitive part of the retina. This fluid build-up is called macular edema. Another symptom is double vision, which occurs when the nerves controlling the eye muscles are affected.

If you experience any of these symptoms, see your eye doctor immediately. If you are diabetic, you should see your eye doctor at least once a year for a dilated eye exam, even if you have no visual symptoms.

If your eye doctor suspects diabetic retinopathy, a special test called fluorescein angiography may be performed. In this test, dye is injected into the body and then gradually appears within the retina due to blood flow. Your eyecare practitioner will photograph the retina as the dye passes through the blood vessels in the retina. Evaluating these pictures tells your doctor or a retina specialist if signs of diabetic retinopathy exist, and how far the disease has progressed.

What causes diabetic retinopathy?

Changes in blood-sugar levels increase your risk of diabetic retinopathy, as does long-term diabetes. Generally, diabetics don't develop diabetic retinopathy until they have had the disease for at least 10 years. As soon as you've been diagnosed with diabetes, you need to have a dilated eye exam at least once a year.

In the retina, high blood sugar can damage blood vessels that can leak fluid or bleed. This causes the retina to swell and form deposits. This is an early form of diabetic retinopathy called non-proliferative or background retinopathy.

In a later stage, called proliferative retinopathy, new blood vessels grow on the surface of the retina. These new blood vessels can lead to serious vision problems because they can break and bleed into the vitreous, the clear, jelly-like substance that fills the interior of the eye. Proliferative retinopathy is a much more serious form of the disease and can lead to blindness.

Fortunately, you can significantly reduce your risk of developing diabetic retinopathy by using common sense and taking good care of yourself:

  • Keep your blood sugar under good control.
  • Maintain a healthy diet.
  • Exercise regularly.
  • Follow your doctor's instructions to the letter.

How is diabetic retinopathy treated?

According to the American Academy of Ophthalmology, 95% of those with diabetic retinopathy can avoid substantial vision loss if they are treated in time.

Diabetic retinopathy can be treated with a laser to seal off leaking blood vessels and inhibit the growth of new vessels. Called laser photocoagulation, this treatment is painless and takes only a few minutes.

In some patients, blood leaks into the vitreous humor and clouds vision. The eye doctor may choose to simply wait to see if the clouding will dissipate on its own, or a procedure called a vitrectomy may be performed to remove blood that has leaked into the vitreous humor.

Small studies using investigational treatments for diabetic retinopathy have demonstrated significant vision improvement for individuals who are in early stages of the disease. Two medications that are closely related, Lucentis and Avastin, may be able to stop or reverse vision loss, similar to very promising results that have been reported when the two drugs have been used as treatments for macular degeneration.

For more information on diabetic retinopathy, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Dry Eye Syndrome

Dry eye syndrome (DES or "dry eye") is the chronic lack of sufficient lubrication and moisture on the surface of the eye. Its consequences range from minor irritations, to the inability to wear contact lenses and an increased risk of corneal inflammation and eye infections.

Signs and symptoms of dry eye

Persistent dryness, scratchiness and a burning sensation on your eyes are common symptoms of dry eye syndrome. These symptoms alone may be enough for your eye doctor to diagnose dry eye syndrome. Sometimes, he or she may want to measure the amount of tears in your eyes. A thin strip of filter paper placed at the edge of the eye, called a Schirmer test, is one way of measuring this.

Some people with dry eyes also experience a "foreign body sensation" – the feeling that something is in the eye. And it may seem odd, but sometimes dry eye syndrome can cause watery eyes, because the excessive dryness works to overstimulate production of the watery component of your eye's tears.

What causes dry eyes?

In dry eye syndrome, the tear glands that moisturize the eye don't produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.

Dry eye syndrome has several causes. It occurs:

        As a part of the natural aging process, especially among women over age 40.

        As a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills.

        Because you live in a dry, dusty or windy climate with low humidity.

If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.

Dry eyes are also associated with certain systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren's syndrome (a triad of dry eyes, dry mouth, and rheumatoid arthritis or lupus).

Long-term contact lens wear, incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes.

Dry eye syndrome is more common in women, possibly due to hormone fluctuations. Recent research suggests that smoking, too, can increase your risk of dry eye syndrome. Dry eye has also been associated with incomplete lid closure following blepharoplasty – a popular cosmetic surgery to eliminate droopy eyelids.

Treatment for dry eye

Dry eye syndrome is an ongoing condition that treatments may be unable to cure. But the symptoms of dry eye – including dryness, scratchiness and burning – can usually be successfully managed.

Your eyecare practitioner may recommend artificial tears, which are lubricating eyedrops that may alleviate the dry, scratching feeling and foreign body sensation of dry eye. Prescription eye drops for dry eye go one step further: they help increase your tear production.

If you wear contact lenses, be aware that many artificial tears cannot be used during contact lens wear. You may need to remove your lenses before using the drops. Wait 15 minutes or longer (check the label) before reinserting them. For mild dry eye, contact lens rewetting drops may be sufficient to make your eyes feel better, but the effect is usually only temporary. Switching to another lens brand could also help.

Check the label, but better yet, check with your doctor before buying any over-the-counter eye drops. Your eye doctor will know which formulas are effective and long-lasting and which are not, as well as which eye drops will work with your contact lenses.

To reduce the effects of sun, wind and dust on dry eyes, wear sunglasses when outdoors. Wraparound styles offer the best protection.

Indoors, an air cleaner can filter out dust and other particles from the air, while a humidifier adds moisture to air that's too dry because of air conditioning or heating.

For more significant cases of dry eye, your eye doctor may recommend punctal plugs. These tiny devices are inserted in ducts in your lids to slow the drainage of tears away from your eyes, thereby keeping your eyes more moist.

Doctors sometimes recommend special nutritional supplements containing certain essential fatty acids to decrease dry eye symptoms. Drinking more water may also relieve symptoms.

If medications are the cause of dry eyes, discontinuing the drug generally resolves the problem. But in this case, the benefits of the drug must be weighed against the side effect of dry eyes. Sometimes switching to a different type of medication alleviates the dry eye symptoms while keeping the needed treatment. In any case, never switch or discontinue your medications without consulting with your doctor first.

Treating any underlying eyelid disease, such as blepharitis, helps as well. This may call for antibiotic or steroid drops, plus frequent eyelid scrubs with an antibacterial shampoo.

If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until your dry eye condition is successfully treated. Dry eyes increase your risk for poor healing after LASIK, so most surgeons will want to treat the dry eyes first, to ensure a good LASIK outcome. This goes for other types of vision correction surgery, as well.

For more information on dry eyes and eye nutrition, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Eye Allergies

Similar to processes that occur with other types of allergic responses, the eye may overreact to a substance perceived as harmful even though it may not be. For example, dust that is harmless to most people can cause excessive tear production and mucus in eyes of overly sensitive, allergic individuals. Eye allergies are often hereditary.

Allergies can trigger other problems, such as conjunctivitis (pink eye) and asthma. Most of the more than 22 million Americans who suffer from allergies also have allergic conjunctivitis, according to the American Academy of Ophthalmology.

Allergy signs and symptoms

Common signs of allergies include: red, swollen, tearing or itchy eyes; runny nose; sneezing; coughing; difficulty breathing; itchy nose, mouth or throat, and headache from sinus congestion.

What causes eye allergies?

Many allergens (substances that can evoke an allergic response) are in the air, where they come in contact with your eyes and nose. Airborne allergens include pollen, mold, dust and pet dander. Other causes of allergies, such as certain foods or bee stings, do not typically affect the eyes the way airborne allergens do. Adverse reactions to certain cosmetics or drugs such as antibiotic eyedrops also may cause eye allergies.

Eye allergy treatment

Avoidance. The most common "treatment" is to avoid what's causing your eye allergy. Itchy eyes? Keep your home free of pet dander and dust, and stay inside with the air conditioner on when a lot of pollen is in the air. If you have central air conditioning, use a high quality filter that can trap most airborne allergens and replace it frequently.

Medications.If you're not sure what's causing your eye allergies, or you're not having any luck avoiding them, your next step will probably be medication to alleviate the symptoms.

Over-the-counter and prescription medications each have their advantages; for example, over-the-counter products are often less expensive, while prescription ones are often stronger.

Eyedrops are available as simple eye washes, or they may have one or more active ingredients such as antihistamines, decongestants or mast cell stabilizers. Antihistamines relieve many symptoms caused by airborne allergens, such as itchy, watery eyes, runny nose and sneezing.

Decongestants clear up redness. They contain vasoconstrictors, which make the blood vessels in your eyes smaller, lessening the apparent redness. They treat the symptom, not the cause.

In fact, with extended use, the blood vessels can become dependent on the vasoconstrictor to stay small. When you discontinue the eyedrops, the vessels actually get bigger than they were in the first place. This process is called rebound hyperemia, and the result is that your red eyes worsen over time.

Some products have ingredients that act as mast cell stabilizers, which alleviate redness and swelling. Mast cell stabilizers are similar to antihistamines. But while antihistamines are known for their immediate relief, mast cell stabilizers are known for their long-lasting relief.

Other medications used for allergies include non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids.  In some cases, combinations of medications may be used.

Immunotherapy. You may also benefit from immunotherapy, in which an allergy specialist injects you with small amounts of allergens to help your body gradually build up immunity to them.

Eye allergies and contact lenses

Even if you are generally a successful contact lens wearer, allergy season can make your contacts uncomfortable. Airborne allergens can get on your lenses, causing discomfort. Allergens can also stimulate the excessive production of natural substances in your tears that bind to your contacts, adding to your discomfort and allergy symptoms.

Ask your eye doctor about eyedrops that can help relieve your symptoms and keep your contact lenses clean. Certain drops can discolor or damage contact lenses, so ask your doctor first before trying out a new brand.

Another alternative is daily disposable contact lenses, which are discarded nightly. Because you replace them so frequently, these lenses are unlikely to develop irritating deposits that can build up over time and cause or heighten allergy-related discomfort.

For more information on eye allergies and pink eye, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Floaters and Spots

Have you ever seen small specks or debris that looks like pieces of lint floating in your field of view? These are called "floaters," and they are usually normal and harmless. They usually can be seen most easily when you look at a plain background, like a blank wall or blue sky.

Floaters are actually tiny clumps of gel or cells inside the vitreous – the clear, jelly-like fluid that fills the inside of your eye.

Floaters may look like specks, strands, webs or other shapes. Actually, what you are seeing are the shadows of floaters cast on the retina, the light-sensitive inner lining of the back of the eye.

Signs and symptoms of floaters and spots

With special exam lights, your eye doctor can detect floaters in your eyes even if you don't notice them yourself.

If a spot or shadowy shape passes in front of your field of vision or to the side, you are seeing a floater. Because they are inside your eye and suspended within the gel-like vitreous, they move with your eyes when you try to see them.

What causes floaters and spots?

Some floaters are present since birth as part of the eye's development, and others occur over time.

When people reach middle age, the gel-like vitreous begins to liquefy and contract. Some parts of the vitreous form clumps or strands inside the eye. The vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment (PVD). PVD is a common cause of floaters.

Floaters are also more common among people who:

  • Are nearsighted.
  • Have undergone cataract surgery.
  • Have had laser surgery of the eye.
  • Have had inflammation inside the eye.

Treatment for floaters and spots

Most spots and floaters in the eye are harmless and merely annoying. Many will fade over time and become less bothersome. People sometimes are interested in surgery to remove floaters, but doctors are willing to perform such surgery only in rare instances.

Flashes of Light

You may also see flashes of light. These flashes occur more often in older people, and usually are caused by mechanical stimulation of photoreceptors when the gel-like vitreous occasionally tugs on the light-sensitive retina. They may be a warning sign of a detached retina – a very serious problem that could lead to blindness if not treated quickly.

Some people experience flashes of light that appear as jagged lines or "heat waves" in both eyes, often lasting 10-20 minutes. These types of flashes are usually caused by a spasm of blood vessels in the brain, which is called a migraine. If a headache follows the flashes, it is called a migraine headache. However, jagged lines or "heat waves" can occur without a headache. In this case, the light flashes are called an ophthalmic migraine, or a migraine without a headache.

However, the sudden appearance of a significant number of floaters, especially if they are accompanied by flashes of light or other vision disturbances, could indicate a retinal detachment or other serious problem in the eye. If you suddenly see new floaters, visit your eye doctor immediately.

For more information on floaters or ocular migraines, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Glaucoma

Glaucoma refers to a category of eye disorders often associated with a dangerous buildup of internal eye pressure (intraocular pressure or IOP), which can damage the eye's optic nerve – the structure that transmits visual information from the eye to the brain.

Glaucoma typically affects your peripheral vision first. This is why it is such a sneaky disease: You can lose a great deal of your vision from glaucoma before you are aware anything is happening. If uncontrolled or left untreated, glaucoma can eventually lead to blindness.

Glaucoma is currently the second leading cause of blindness in the United States, with an estimated 2.5 million Americans being affected by the disease. Due to the aging of the U.S. population, it's expected that more than 3 million Americans will have glaucoma by the year 2020.

Signs and symptoms of glaucoma

Glaucoma is often referred to as the "silent thief of sight," because most types typically cause no pain and produce no symptoms. For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss.

But there are other forms of the disease (specifically, acute angle-closure glaucoma), where symptoms of blurry vision, halos around lights, intense eye pain, nausea, and vomiting occur suddenly. If you have these symptoms, make sure you immediately see an eye care practitioner or visit the emergency room so steps can be taken to prevent permanent vision loss.

What causes glaucoma?

The cause of glaucoma is generally a failure of the eye to maintain an appropriate balance between the amount of fluid produced inside the eye and the amount that drains away. Underlying reasons for this imbalance usually relate to the type of glaucoma you have.

Just as a basketball or football requires air pressure to maintain its shape, the eyeball needs internal fluid pressure to retain its globe-like shape and ability to see. But when glaucoma damages the ability of internal eye structures to regulate intraocular pressure (IOP), eye pressure can rise to dangerously high levels and vision is lost.

Types of glaucoma

The two major types of glaucoma are chronic or primary open-angle glaucoma (POAG) and acute angle-closure glaucoma. The "angle" refers to the structure inside the eye that is responsible for fluid drainage from the eye, located near the junction between the iris and the front surface of the eye near the periphery of the cornea. Some of the more common types of glaucoma include:

Primary open-angle glaucoma (POAG): About half of Americans with this form of chronic glaucoma don't know they have it. POAG gradually and painlessly reduces your peripheral vision. But by the time you notice it, permanent damage has already occurred. If your IOP remains high, the destruction can progress until tunnel vision develops, and you will be able to see only objects that are straight ahead.

Acute angle-closure glaucoma: Angle-closure or narrow angle glaucoma produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting. These signs may last for a few hours, and then return again for another round. Each attack takes with it part of your field of vision.

Normal-tension glaucoma: Like POAG, normal-tension glaucoma (also termed normal-pressure glaucoma, low-tension glaucoma, or low-pressure glaucoma) is an open-angle type of glaucoma that can cause visual field loss due to optic nerve damage. But in normal-tension glaucoma, the eye's IOP remains in the normal range. Also, pain is unlikely and permanent damage to the eye's optic nerve may not be noticed until symptoms such as tunnel vision occur.

The cause of normal-tension glaucoma is not known. But many doctors believe it is related to poor blood flow to the optic nerve. Normal-tension glaucoma is more common in those who are Japanese, are female and/or have a history of vascular disease.

Congenital glaucoma: This inherited form of glaucoma is present at birth, with 80% of cases diagnosed by age one. These children are born with narrow angles or some other defect in the drainage system of the eye. It's difficult to spot signs of congenital glaucoma, because children are too young to understand what is happening to them. If you notice a cloudy, white, hazy, enlarged or protruding eye in your child, consult your eye doctor. Congenital glaucoma typically occurs more in boys than in girls.

Pigmentary glaucoma: This rare form of glaucoma is caused by pigment deposited from the iris that clogs the draining angles, preventing aqueous humor from leaving the eye. Over time, the inflammatory response to the blocked angle damages the drainage system. You are unlikely to notice any symptoms with pigmentary glaucoma, though some pain and blurry vision may occur after exercise. Pigmentary glaucoma affects mostly white males in their mid-30s to mid-40s.

Secondary glaucoma:Symptoms of chronic glaucoma following an eye injury could indicate secondary glaucoma, which also may develop with presence of infection, inflammation, a tumor or an enlarged cataract.

How is glaucoma detected?

During routine eye exams, a tonometer is used to measure your intraocular pressure (IOP). Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers direct a puff of air onto your eye's surface to indirectly measure IOP.

An abnormally high IOP reading indicates a problem with the amount of fluid inside the eye. Either the eye is producing too much fluid, or it's not draining properly.

Another method for detecting or monitoring glaucoma is the use of instruments to create images of the eye's optic nerve and then repeating this imaging over time to see if changes to the optic nerve are taking place, which might indicate progressive glaucoma damage. Instruments used for this purpose include scanning laser polarimetry (SLP), optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy.

Visual field testing is another way to monitor whether blind spots are developing in your field of vision from glaucoma damage to the optic nerve. Visual field testing involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals so your eye doctor can determine if there is progressive vision loss.

Instruments such as an ophthalmoscope also may be used to help your eye doctor view internal eye structures, to make sure nothing unusual interferes with the outflow and drainage of eye fluids. Ultrasound biomicroscopy also may be used to evaluate how well fluids flow through the eye's internal structures. Gonioscopy is the use of special lenses that allow your eye doctor to visually inspect internal eye structures that control fluid drainage.

Glaucoma treatments

Depending on the severity of the disease, treatment for glaucoma can involve the use of medications, conventional (bladed) surgery, laser surgery or a combination of these treatments. Medicated eye drops aimed at lowering IOP usually are tried first to control glaucoma.

Because glaucoma is often painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage. In fact, non-compliance with a program of prescribed glaucoma medication is a major reason for blindness resulting from glaucoma.

If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.

All glaucoma surgery procedures (whether laser or non-laser) are designed to accomplish one of two basic results: decrease the production of intraocular fluid or increase the outflow (drainage) of this same fluid. Occasionally, a procedure will accomplish both.

Currently the goal of glaucoma surgery and other glaucoma therapy is to reduce or stabilize intraocular pressure (IOP). When this goal is accomplished, damage to ocular structures – especially the optic nerve – may be prevented.

Early detection is key

No matter the treatment, early diagnosis is the best way to prevent vision loss from glaucoma. See your eye care practitioner routinely for a complete eye examination, including a check of your IOP.

People at high risk for glaucoma due to elevated intraocular pressure, a family history of glaucoma, advanced age or an unusual optic nerve appearance may need more frequent visits to the eye doctor.

For more information on glaucoma and glaucoma treatment, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Hyperopia

Hyperopia, or farsightedness, is a common vision problem affecting about 25% of the U.S.  population. People with hyperopia can usually see distant objects well, but have difficulty seeing objects that are up close.

Signs and symptoms of hyperopia

Farsighted people sometimes have headaches or eyestrain, and may squint or feel fatigued when performing work at close range. If you get these symptoms while wearing your glasses or contact lenses, you may need an eye exam and a new prescription.

What causes hyperopia?

Farsightedness occurs when light rays entering the eye focus behind the retina, rather than directly on it. The eyeball of a farsighted person is often shorter than normal.

Many children are born with hyperopia, and some of them "outgrow" it as the eyeball lengthens with normal growth.

People sometimes confuse hyperopia with presbyopia, which also involves difficulty with seeing up close. But presbyopia has a different cause and occurs after age 40.

Hyperopia treatment

Eyeglasses or contact lenses can correct farsightedness to change the way light rays bend into the eyes. If your glasses or contact lens prescription begins with plus numbers, like +2.50, you are farsighted.

Depending on the amount of farsightedness you have, you may need to wear your glasses or contacts all the time, or only when reading, working on a computer or doing other close-up work.

Refractive surgery, such as LASIK or PRK, is another option for correcting hyperopia.

For more information on hyperopia, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Keratoconus

Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. Keratoconus can occur in one or both eyes.

Keratoconus is relatively rare. Most studies indicate it occurs in 0.15% to 0.6% of the general U.S. population. Onset of the disease usually occurs in people in their teens or early twenties.

Signs and symptoms of keratoconus

Keratoconus can be difficult to detect, because it usually develops slowly. However, in some cases, it may proceed rapidly. As the cornea becomes more irregular in shape, it causes a progressive increase in nearsightedness and irregular astigmatism, creating problems with distorted and blurred vision. Glare and light sensitivity also may be noticed.

Keratoconic patients often have prescription changes every time they visit their eye care practitioner. It's not unusual to have a delayed diagnosis of keratoconus, if the practitioner is unfamiliar with the early-stage symptoms of the disease.

What causes keratoconus?

Research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward.

Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one member of the same family. Keratoconus is also associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fit contact lenses and chronic eye irritation.

Keratoconus treatment

For the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses or soft contacts no longer provide adequate vision correction.

Treatments for moderate and advanced keratoconus include:

Gas permeable contact lenses: If eyeglasses or soft contact lenses cannot control keratoconus, then gas permeable (GP) contact lenses are usually the preferred treatment. The rigid lens material enables GP lenses to vault over the cornea, replacing the cornea's irregular shape with a smooth, uniform refracting surface to improve vision.

But GP contact lenses can be less comfortable to wear than soft lenses. Also, fitting contact lenses on a keratoconic cornea is challenging and time-consuming. You can expect frequent return visits to fine-tune the fit and the prescription, especially if the keratoconus continues to progress.

"Piggybacking" contact lenses: Because fitting a gas permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for the individual with keratoconus, some eye care practitioners advocate "piggybacking" two different types of contact lenses on the same eye. For keratoconus, this method involves placing a soft contact lens on the eye and then fitting a GP lens over the soft lens. This approach increases wearer comfort because the soft lens acts like a cushioning pad under the rigid GP lens.

Hybrid contact lenses: Hybrid contact lenses have a relatively new design that combines a highly oxygen-permeable rigid center with a soft peripheral "skirt." Manufacturers of these lenses claim hybrid contacts provide the crisp optics of a GP lens and wearing comfort that rivals that of soft contact lenses. Hybrid lenses are also available in a wide variety of parameters to provide a fit that conforms well to the irregular shape of a keratoconic eye.

Intacs: These tiny plastic inserts are surgically placed just under the eye's surface in the periphery of the cornea, and help re-shape the cornea for clearer vision. Intacs may be needed when keratoconus patients no longer can obtain functional vision with contact lenses or eyeglasses.

Several studies show that Intacs can improve the best spectacle-corrected visual acuity (BSCVA) of a keratoconic eye by an average of two lines on a standard eye chart. The implants also have the advantage of being removable and exchangeable. The surgical procedure takes only about 10 minutes. Intacs might delay but can't prevent a corneal transplant if keratoconus continues to progress.

C3-R (corneal collagen cross-linking with riboflavin): This investigational, non-invasive procedure involves placing eye drops containing riboflavin (vitamin B2) on the cornea, which are then activated by ultraviolet (UV) light to strengthen links between the connective tissue (collagen) fibers within the cornea.

Studies of the C3-R procedure have shown promising results. In one small German study, progression of keratoconus was stopped in all of the 23 eyes studied. Most patients also had some reversal of keratoconus and minor vision improvement. Researchers concluded that this simple method of treatment might significantly reduce the need for corneal transplants among keratoconus patients.

Corneal transplant: Some people with keratoconus can't tolerate a rigid contact lens, or they reach the point where contact lenses or other therapies no longer provide acceptable vision. The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty (PK or PKP). Even after a successful cornea transplant, most keratoconic patients still need glasses or contact lenses for clear vision.

For more information on keratoconus, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Macular Degeneration

Macular degeneration (also called AMD, ARMD, or age-related macular degeneration) is an age-related condition in which the most sensitive part of the retina, called the macula, starts to break down and lose its ability to create clear visual images. The macula is responsible for central vision – the part of our sight we use to read, drive and recognize faces. So although a person's peripheral vision is left unaffected by AMD, the most important aspect of vision is lost.

AMD is the leading cause of vision loss and blindness in Americans of ages 65 and older. And because older people represent an increasingly larger percentage of the general population, vision loss associated with macular degeneration is a growing problem.

It's estimated that more than 1.75 million U.S. residents currently have significant vision loss from AMD, and that number is expected to grow to almost 3 million by 2020.

The two forms of AMD

Macular degeneration can be classified as either dry (non-neovascular) or wet (neovascular). Neovascular refers to growth of new blood vessels in an area, such as the macula, where they are not supposed to be.

The dry form of AMD is more common – about 85% to 90% of all cases of macular degeneration are the dry variety.

Dry macular degeneration - Dry AMD is an early stage of the disease, and may result from the aging and thinning of macular tissues, depositing of pigment in the macula, or a combination of the two processes.

Dry macular degeneration is diagnosed when yellowish spots called drusen begin to accumulate in the macula. Drusen are believed to be deposits or debris from deteriorating macular tissue. Gradual central vision loss may occur with dry AMD. Vision loss from this form of the disease is usually not as severe as that caused by wet AMD.

A major study conducted by the National Eye Institute (NEI) looked into the risk factors for developing macular degeneration and cataracts. The study, called the Age-Related Eye Disease Study (AREDS), showed that high levels of antioxidants and zinc significantly reduce the risk of advanced dry AMD and its associated vision loss.

The AREDS study also indicated that taking high dose formulas containing beta carotene, vitamins C and E and zinc can reduce the risk of early stage AMD progression by 25%.

Wet macular degeneration - Wet AMD is the more advanced and damaging stage of the disease. In about 10% of cases, dry AMD progresses to wet macular degeneration.

With wet AMD, new blood vessels grow beneath the retina and leak blood and fluid. This leakage causes permanent damage to light-sensitive cells in the retina, causing blind spots or a total loss of central vision.

The abnormal blood vessel growth in wet AMD is the body's misguided attempt to create a new network of blood vessels to supply more nutrients and oxygen to the macula. But the process instead creates scarring and central vision loss.

Macular degeneration signs and symptoms

Macular degeneration usually produces a slow, painless loss of vision. Early signs of vision loss associated with AMD can include seeing shadowy areas in your central vision or experiencing unusually fuzzy or distorted vision. In rare cases, AMD may cause a sudden loss of central vision.

An eyecare practitioner usually can detect early signs of macular degeneration before symptoms occur. Usually this is accomplished through a retinal examination.

What causes macular degeneration?

Many forms of macular degeneration appear be linked to aging and related deterioration of eye tissue crucial for good vision. Research also suggests a gene deficiency may be associated with almost half of all potentially blinding cases of macular degeneration.

Who gets macular degeneration?

Besides affecting older individuals, AMD appears to occur in whites and females in particular. The disease also can result as a side effect of some drugs, and it appears to run in families.

New evidence strongly suggests that smoking is high on the list of risk factors for macular degeneration. Other risk factors for AMD include having a family member with AMD, high blood pressure, lighter eye color and obesity. Some researchers believe that over-exposure to sunlight also may be a contributing factor in development of macular degeneration, and a high-fat diet also may be a risk factor.

How is macular degeneration treated?

There is as yet no outright cure for macular degeneration, but some treatments may delay its progression or even improve vision.

There are no FDA-approved treatments for dry AMD, although nutritional intervention may be valuable in preventing its progression to the more advanced, wet form.

For wet AMD, there are several FDA-approved drugs aimed at stopping abnormal blood vessel growth and vision loss from the disease. In some cases, laser treatment of the retina may be recommended. Ask your eye doctor for details about the latest treatment options for wet AMD.

Testing and low vision devices

Although much progress has been made recently in macular degeneration treatment research, complete recovery of vision lost to AMD probably is unlikely. Your eye doctor may ask you to check your vision regularly with an Amsler grid – a small chart of thin black lines arranged in a grid pattern. AMD causes the line on the grid to appear wavy, distorted or broken. Viewing the Amsler grid separately with each eye helps you monitor your vision loss.

If you have already suffered vision loss from AMD, low vision devices including high magnification reading glasses and hand-held telescopes may help you achieve better vision than regular prescription eyewear.

For more information on macular degeneration or to use an Amsler Grid, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Myopia

Myopia, or nearsightedness, is a very common vision problem. It's estimated that up to one-third of Americans are nearsighted.

Nearsighted people have difficulty reading road signs and seeing distant objects clearly, but can see well for up-close tasks such as reading or sewing.

Signs and symptoms of myopia

Nearsighted people often have headaches or eyestrain, and might squint or feel fatigued when driving or playing sports. If you experience these symptoms while wearing your glasses or contact lenses, you may need a stronger prescription.

What causes myopia?

Myopia occurs when the eyeball is slightly longer than usual from front to back. This causes light rays to focus at a point in front of the retina, rather than directly on its surface.

Nearsightedness runs in families and usually appears in childhood. This vision problem may stabilize at a certain point, although sometimes it worsens with age.

Myopia treatment

Nearsightedness may be corrected with glasses, contact lenses or refractive surgery. Depending on the degree of your myopia, you may need to wear eyeglasses or contact lenses all the time, or only when you need sharper distance vision, like when driving, viewing a chalkboard or watching a movie.

If your glasses or contact lens prescription begins with minus numbers, like -2.50, you are nearsighted.

Refractive surgery is another option for correcting myopia. This includes laser procedures such as LASIK and PRK, or non-laser options such as corneal inserts and implantable lenses. One advantage of the non-laser options is that, although they're intended to be permanent, they may be removed in case of a problem or change of prescription.

Then there's orthokeratology, a non-surgical procedure where you wear special rigid gas permeable (GP) contact lenses that slowly reshape the cornea over time to correct your myopia. When the lenses are removed, the cornea temporarily retains the new shape, so you can see clearly without the lenses. These cornea-shaping lenses are worn during sleep, so you have daytime vision without contacts or glasses.

For more information on myopia or orthokeratology, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Ocular Hypertension

Ocular hypertension means the pressure in your eye, or your intraocular pressure (IOP), is higher than normal levels. Elevated IOP is also associated with glaucoma, which is a more serious condition that causes vision loss and optic nerve damage. By itself, however, ocular hypertension doesn't damage your vision or eyes.

Studies suggest that 2% to 3% of the general population may have ocular hypertension.

Signs and symptoms of ocular hypertension

You can't tell by yourself that you have ocular hypertension, because there are no outward signs or symptoms such as pain or redness. At each eye exam, your eyecare practitioner will measure your IOP and compare it to normal levels.

During routine eye exams, a tonometer is used to measure your IOP. Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers direct a puff of air onto your eye's surface to indirectly measure IOP.

What causes ocular hypertension?

Anyone can develop ocular hypertension, but it's most common in African-Americans, people over 40, those with family history of ocular hypertension or glaucoma, and those with diabetes or high amounts of nearsightedness.

IOP may become elevated due to excessive aqueous fluid production or inadequate drainage. Certain medications, such as steroids, and trauma can cause higher-than-normal IOP measurements as well.

Ocular hypertension treatment

People with ocular hypertension are at increased risk for developing glaucoma, so some eye doctors prescribe medicated eye drops to lower IOP in cases of ocular hypertension. Because these medications can be expensive and may have side effects, other eye doctors choose to monitor your IOP and only take action if you show signs of developing glaucoma. Because of the increased risk for glaucoma, you should have your IOP measured at the intervals your doctor recommends if you have ocular hypertension.

For more information on ocular hypertension or glaucoma, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Pingueculae

Pingueculae (singular form = piguecula) are yellowish, slightly raised lesions that form on the surface tissue of the white part of your eye (sclera), close to the edge of the cornea. They are typically found in the open space between your eyelids, which also happens to be the area exposed to the sun.

While pingueculae are more common in middle-aged or older people who spend significant amounts of time in the sun, they can also be found in younger people and even children – especially those who spend a lot of time in the sun without protection such as sunglasses or hats.

Signs and symptoms of pingueculae

In most people, pingueculae cause few symptoms. However, a pinguecula that is irritated might create a feeling that something is in the eye – called a foreign body sensation. In some cases, pingueculae can become swollen and inflamed, a condition called pingueculitis. Irritation and eye redness from pingueculitis usually result from exposure to sun, wind, dust, or extremely dry conditions.

Treatment of pingueculae

The treatment for pingueculae depends on the severity of the growth and its symptoms. Everyone with pingueculae can benefit from sun protection for their eyes. Lubricating eye drops may be prescribed for those with mild pingueculitis to relieve dry eye irritation and foreign body sensation. To relieve significant inflammation and swelling, steroid eye drops or non-steroidal anti-inflammatory drugs may be needed.

Surgical removal of the pinguecula may be considered in severe cases where there is interference with vision, contact lens wear or normal blinking.

Frequently, pingueculae can lead to the formation of pterygia.

Pterygia

Pterygia (singular form = pterygium) are wedge- or wing-shaped growths of benign fibrous tissue on the surface tissue of the sclera. Because pterygia also contain blood vessels, they are considered a fibrovascular growth. In extreme cases, pterygia may grow onto the eye's cornea and interfere with vision.

Because a pterygium is usually quite visible to others, a person who has one may become concerned about their personal appearance. As with pingueculae, prolonged exposure to ultraviolet light from the sun may play a role in the formation of pterygia.

Signs and symptoms of pterygia

Many people with pterygia do not experience symptoms or require treatment. Some pterygia may become red and swollen on occasion, and some may become large or thick. This may cause concern about appearance or create a feeling of having a foreign body in the eye. Large and advanced pterygia can actually cause a distortion of the surface of the cornea and induce astigmatism and blurred vision.

How pterygia are treated

Treatment depends on the pterygium's size and the symptoms it causes. If a pterygium is small but becomes inflamed, your eye doctor may prescribe lubricants or possibly a mild steroid eye drop to reduce swelling and redness. In some cases, surgical removal of the pterygium is necessary.

The pterygia may be removed in a procedure room at the doctor's office or in an operating room setting. A number of surgical techniques are currently used to remove pterygia, and it is up to your eye doctor to determine the best procedure for you.

After the procedure, which usually lasts no longer than 30 minutes, you may need to wear an eye patch for protection for a day or two. For uncomplicated surgery, you should be able to return to work or normal activities the next day.

Unfortunately, pterygia often return after surgical removal. In fact, the recurrence rate can be as high as 40%. To prevent regrowth after the pterygium is surgically removed, your eye surgeon may suture or glue a piece of surface eye tissue onto the affected area. This method, called autologous conjunctival autografting, is safe and lowers the chance of the pterygium growing back. After removal of the pterygium, steroid eye drops may be used for several weeks to decrease swelling and prevent regrowth.

It is important to note that pterygium removal can also induce astigmatism, especially in patients who already have astigmatism.

For more information on eye conditions, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Pink Eye (Conjunctivitis)

Technically, pink eye is the acute, contagious form of conjunctivitis – inflammation of the clear mucous membrane that lines the inner surface of the eyelids and overlies the white front surface of the eye, or sclera. Bacterial infection causes the contagious form of conjunctivitis.

However, the term "pink eye" is often used to refer to any or all types of conjunctivitis, not just its acute, contagious form.

Signs and symptoms of pink eye

The hallmark sign of pink eye is a pink or reddish appearance to the eye due to inflammation and dilation of conjunctival blood vessels. Depending on the type of conjunctivitis, other signs and symptoms may include a yellow or green mucous discharge, watery eyes, itchy eyes, sensitivity to light and pain. 

How can you tell what type of pink eye you have? The way your eyes feel will provide some clues:

  • Viral conjunctivitis usually causes excessive eye watering and a light discharge.
     
  • Bacterial conjunctivitis often causes a thick, sticky discharge, sometimes greenish.
     
  • Allergic conjunctivitis affects both eyes and causes itching and redness in the eyes and sometimes the nose, as well as excessive tearing.
     
  • Giant papillary conjunctivitis (GPC) usually affects both eyes and causes contact lens intolerance, itching, a heavy discharge, tearing and red bumps on the underside of the eyelids.

To pinpoint the cause and then choose an appropriate treatment, your eye doctor will ask some questions, examine your eyes and possibly collect a sample on a swab to send out for analysis.

What causes pink eye?

Though pink eye can affect people of any age, it is especially common among preschoolers and school children because of the amount of bacteria transferred among children.

Conjunctivitis may also be triggered by a virus, an allergic reaction (to dust, pollen, smoke, fumes or chemicals) or, in the case of giant papillary conjunctivitis, a foreign body on the eye, typically a contact lens. Bacterial and viral infections elsewhere in the body may also induce conjunctivitis.

Treatment of pink eye

Avoidance. Your first line of defense is to avoid the cause of conjunctivitis, such as contaminated hand towels. Both viral and bacterial conjunctivitis, which can be caused by airborne sources, spread easily to others.

To avoid allergic conjunctivitis, keep windows and doors closed on days when the airborne pollen count is high. Dust and vacuum frequently to eliminate potential allergens in the home.

Stay in well-ventilated areas if you're exposed to smoke, chemicals or fumes. If you do experience exposure to these substances, cold compresses over your closed eyes can be very soothing.

If you've developed giant papillary conjunctivitis, odds are that you're a contact lens wearer. You'll need to stop wearing your contact lenses, at least for a little while. Your eye doctor may also recommend that you switch to a different type of contact lens, to reduce the chance of the conjunctivitis coming back.

Medication. Unless there's some special reason to do so, eye doctors don't normally prescribe medication for viral conjunctivitis, because it usually clears up on its own within a few days. Your eye doctor might prescribe an astringent to keep your eyes clean, to prevent a bacterial infection from starting. Another common prescription is for artificial tears, to relieve dryness and discomfort.

Antibiotic eyedrops or ointments will alleviate most forms of bacterial conjunctivitis, while antibiotic tablets are used for certain infections that originate elsewhere in the body.

Antihistamine allergy pills or eyedrops will help control allergic conjunctivitis symptoms. In addition, artificial tears provide comfort, but they also protect the eye's surface from allergens and dilute the allergens that are present in the tear film.

For giant papillary conjunctivitis, your doctor may prescribe eyedrops to reduce inflammation and itching.

Usually conjunctivitis is a minor eye infection. But sometimes it can develop into a more serious condition. See your eye doctor for a diagnosis before using any eye drops in your medicine cabinet from previous infections or eye problems.

Prevention tips

Because young children often are in close contact in day care centers and school rooms, it can be difficult to avoid the spread of bacteria causing pink eye. However, these tips can help concerned parents, day care workers and teachers reduce the possibility of a pink eye outbreak in institutional environments:

  • Adults in school and day care centers should wash their hands frequently and encourage children to do the same. Soap should always be available for hand washing.
     
  • Personal items, including hand towels, should never be shared at school or at home.
     
  • Encourage children to use tissues and cover their mouths and noses when they sneeze or cough.
     
  • Discourage eye rubbing and touching, to avoid spread of bacteria and viruses.
     
  • For about three to five days, children (and adults) diagnosed with pink eye should avoid crowded conditions where the infection could easily spread.
       
  • Use antiseptic and/or antibacterial solutions to clean and wipe surfaces that children or adults come in contact with, such as common toys, table tops, drinking fountains, sink/faucet handles, etc.

For more information on pink eye or types of conjunctivitis, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Presbyopia

Some time after age 40, people begin to experience blurred near vision when performing tasks such as reading, sewing or working at a computer. This change is called presbyopia. There's no getting around it — presbyopia happens to everyone at some point in life, even those who have never had a vision problem before.

Currently an estimated 90 million people in the United States either have presbyopia or will develop it by 2014. This is generating a huge demand for eyewear, contact lenses and surgery that can help older Americans deal with their failing near vision.

Presbyopia signs and symptoms

With the onset of presbyopia, you'll find you need to hold books, magazines, newspapers, menus and other reading materials farther away in order to see the print clearly. Headaches and eyestrain when reading or performing other near work after age 40 are other symptoms of presbyopia.

What causes presbyopia?

Presbyopia is an age-related loss of flexibility of the lens inside the eye. This is different from astigmatism, nearsightedness and farsightedness, which are related to the shape of the eyeball and occur early in life. When the lens becomes hardened and less elastic, the eye has a harder time focusing up close.

Presbyopia treatment: Eyewear

Eyeglasses with bifocal or progressive addition lenses (PALs) are the most common correction for presbyopia.

"Bifocal" means two points of focus: the main part of the eyeglass lens contains a prescription for nearsightedness, farsightedness and/or astigmatism, while the lower portion of the lens holds the stronger near prescription for close work. Progressive addition lenses are multifocal lenses that offer a gradual transition between a number of lens powers for different viewing distances, with no visible lines in the lens.

Reading glasses are another choice. Unlike bifocals and PALs, which most people wear all day, reading glasses are typically worn just during close work. If you wear contact lenses, your eye doctor can prescribe reading glasses to wear over your contacts for near vision tasks. You may also purchase non-prescription "readers" over-the-counter at a retail store for the same purpose.

Multifocal contact lenses, available in gas permeable (GP) or soft lens materials, also are available for presbyopes.

Another type of contact lens correction for presbyopia is monovision, in which one eye wears a distance prescription, and the other wears a prescription for near vision. The brain learns to favor one eye or the other for different tasks.

Because changes in the lens of your eye continue as you grow older, your presbyopic prescription will increase over time. Your eyecare practitioner will prescribe a stronger correction for near work as you need it.

Presbyopia treatment: Surgery

Surgical options for the correction of presbyopia also exist. If you also have nearsightedness, farsightedness or astigmatism, monovision LASIK eye surgery can correct these problems and decrease your dependence on reading glasses as well. It's also expected that a multifocal LASIK treatment option for presbyopia will soon be available in the United States.

If you only need glasses for reading and close work, conductive keratoplasty (CK) may be a good option. This surgical technique is less invasive than LASIK and can be performed on one eye for a monovision correction.

Another surgical treatment for presbyopia is refractive lens exchange (RLE), where your eye's hardened lens is removed and replaced with a special type of intraocular lens (IOL) to restore your distance vision and near vision lost to presbyopia. This procedure is similar to cataract surgery, and is more invasive than CK or LASIK.

Because the field of vision correction surgery is changing rapidly, ask your eye doctor for the latest information about surgery for presbyopia if you are interested in this treatment option.

For more information on presbyopia and bifocals, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Ptosis

Ptosis (pronounced "toe-sis") refers to the drooping of an eyelid. It affects only the upper eyelid of one or both eyes. The droop may be barely noticeable, or the lid can descend over the entire pupil. Ptosis can occur in both children and adults, but happens most often due to aging.

Ptosis signs and symptoms

The most obvious sign of ptosis is a lower-than-normal positioning of one or both of the upper eyelids. Depending on how severely the lid droops, people with ptosis may have difficulty seeing. Sometimes people tilt their heads back to try to see under the lid, or raise their eyebrows repeatedly to try to lift the eyelids.

The degree of droopiness varies from one person to the next. If you think you may have ptosis, compare a recent photo of your face to one from 10 or 20 years ago to see if there is a noticeable change in the position of your upper eyelids.

Ptosis can look similar to dermatochalasis, a group of connective tissue diseases that cause skin to hang in folds. These diseases are associated with less-than-normal elastic tissue formation. Your eye doctor should be able to tell whether or not this is the cause of your drooping eyelids.

What causes ptosis?

Ptosis can be present at birth (congenital ptosis), or develop due to aging, injury or an aftereffect of cataract or other eye surgery. This condition can also be caused by a problem with the muscles that raise the eyelid, called levator muscles. Sometimes an individual's facial anatomy causes difficulties with the levator muscles. An eye tumor, neurological disorder or systemic disease like diabetes may also cause drooping eyelids.

How is ptosis treated?

Surgery is usually the best treatment for drooping eyelids. The surgeon tightens the levator muscles to restore the eyelids to their normal position. In very severe cases involving weakened levator muscles, the surgeon attaches the eyelid under the eyebrow to allow the forehead muscles to substitute for the levator muscles in lifting the eyelid. Eyelid surgery is also known as blepharoplasty.

After surgery, the eyelids may not appear symmetrical, even though the lids are higher than before surgery. Very rarely, eyelid movement may be lost.

It is important to choose your blepharoplasty surgeon carefully, since a poorly-done surgery could result in a less than desirable appearance or in dry eyes caused by your lids not being able to close properly after surgery. Before agreeing to ptosis surgery, ask how many procedures your surgeon has done. Also ask to see before-and-after photos of previous patients, and ask if you can talk to any of them about their experience.

Ptosis in children

Children born with moderate or severe ptosis require treatment in order for proper vision to develop. Failure to treat ptosis can result in amblyopia (diminished vision in one eye) and a lifetime of poor vision. All children with ptosis, even mild cases, should visit their eyecare practitioner every year so the doctor can monitor lid positioning and potential vision problems caused by congenital ptosis.

For more information on eye conditions, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Retinal Detachment

A retinal detachment is a serious and sight-threatening event, occurring when the retina – the light-sensitive inner lining of the back of the eye – becomes separated from its underlying supportive tissue. The retina cannot function when it detaches and, unless it is reattached soon, permanent vision loss may result.

Signs and symptoms of retinal detachment

If you suddenly notice spots, floaters and flashes of light, you may be experiencing a retinal detachment. Your vision might become blurry, or you might have poor vision. Another symptom is seeing a shadow or a curtain coming down from the top of the eye or across from the side. These symptoms can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches immediately.

There is no pain associated with retinal detachment. If you experience any of the above symptoms, consult your eye doctor right away. Immediate treatment increases your odds of regaining lost vision.

What causes retinal detachments?

An injury to the eye or face can cause a detached retina, as can very high levels of nearsightedness. Extremely nearsighted people have longer eyeballs with thinner retinas that may be more prone to detaching.

On rare occasions, retinal detachment may occur after LASIK surgery in highly nearsighted individuals. In a study of more than 1,500 LASIK patients, just four suffered retinal detachment; their pre-LASIK prescriptions ranged from -8.00 D to -27.50 D.

Cataract surgery, tumors, eye disease and systemic diseases such as diabetes and sickle cell disease may also cause retinal detachments. New blood vessels growing under the retina – which can happen in diseases such as diabetic retinopathy – may separate the retina from its underlying support tissue as well.

Treatment for retinal tears and detachments

Surgery is the only effective treatment for a torn or detached retina. The procedure or combination of procedures your doctor uses depends on the severity and location of the problem.

Laser surgery. Also called photocoagulation, laser surgery is generally used for retinal breaks and tears that have not yet become retinal detachments. The surgeon directs a laser beam into your eye through the pupil to "spot weld" the damaged retina to its underlying tissue. Photocoagulation requires no surgical incision and causes less irritation to the eye than other treatments.

Cryopexy. In this treatment, the surgeon applies a freezing probe to the outer surface of the eye over the area of defective retina. The scarring that occurs from the freezing reattaches the retina to its support tissue.

Pneumatic retinopexy. This surgery is generally used to treat a retinal detachment in the upper half of the retina. The surgeon injects an expandable gas bubble inside the eye, positioning the bubble over the torn and detached retina. As the gas bubble expands, it pushes the detached retina against its support tissue. The surgeon then may use laser photocoagulation or cryopexy to firmly reattach the retina to the underlying tissue. Over time, your body absorbs the gas bubble. Until that occurs, certain precautions are necessary.

In a variation of pneumatic retinopexy, the surgeon may inject silicone oil rather than expandable gas into the eye to press the detached retina against its support tissue. In this procedure, the silicone oil must be removed from the eye after the retina is reattached.

Scleral buckling. This is the most common surgery used to treat a retinal detachment. In this procedure, the surgeon places a soft silicone band around the eye, which indents the outside of the eye toward the detached retina. The band is sutured against the tough outer white coating of the eye (the sclera). The surgeon then drains any fluid between the retina and its support tissue, and reattaches the retina with laser photocoagulation or cryopexy.  

In about 90% of cases, detached retinas are successfully reattached with a single surgery. However, this does not mean your vision will return to normal. Patients who have the best visual outcomes from retinal detachment surgery are those who seek attention immediately upon noticing symptoms and have detachments that do not involve the central retina (the macula).

For more detached retina information, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Retinitis Pigmentosa

Retinitis pigmentosa (RP) is a rare, inherited eye disease in which the light-sensitive retina slowly and progressively degenerates. This causes progressive peripheral vision loss, night blindness, central vision loss and, in some cases, blindness.

RP affects approximately 1 out of every 4,000 Americans.

Signs and symptoms of retinitis pigmentosa

The first symptoms of retinitis pigmentosa usually occur in early childhood, when both eyes typically are affected. However, some cases of RP may not become apparent until affected individuals are in their 30s or older.

"Night blindness" is the primary symptom of the disease in its early stages. During later stages of retinitis pigmentosa, tunnel vision can develop, with only a small area of central vision remaining.

In one study of RP patients who were at least 45 years old, 52% had 20/40 or better central vision in at least one eye, 25% had 20/200 or worse vision and 0.5% had no light perception (total blindness).

What causes RP?

Not much is known about what causes retinitis pigmentosa, except that the disease is inherited. It is now believed that RP can be caused by molecular defects in 100 different genes, causing significant variations in the disease from person to person.

Even if your mother and father don't have retinitis pigmentosa, you can still have the eye disease when at least one parent carries an altered gene associated with the trait. In fact, about 1% of the population can be considered carriers of recessive genetic tendencies for retinitis pigmentosa that, in certain circumstances, can be passed on to a child who then develops the disease.

In RP, the light-sensitive cells in the retina gradually die. Usually, cells called rods are primarily affected. These cells are needed for night vision and peripheral vision. However, other cells called cones can also be affected. Cone cells are responsible for our central vision and color vision.

Retinitis Pigmentosa tests and treatment

Visual field testing likely will be done to determine the extent of peripheral vision loss. Other eye exams may be conducted to determine whether you have lost night vision or color vision.

No treatments currently are available for retinitis pigmentosa, although some practitioners believe that vitamin A supplements may delay vision loss.

Illuminated magnifiers and other low vision devices can be helpful to help RP patients get the most out of their remaining vision. Occupational therapy and psychological counseling are also recommended to help the person with RP deal with their vision loss.

Researchers are looking into ways to treat RP in the future, such as retinal implants and drug treatments.

For more information on retinitis pigmentosa and low vision, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Stye

A stye (or hordeolum) develops when an eyelid gland at the base of an eyelash becomes infected. Resembling a pimple on the eyelid, a stye can grow on the inside or outside of the lid. Styes are not harmful to vision, and they can occur at any age.

Signs and symptoms of styes

A stye initially brings pain, redness, tenderness and swelling in the area, and then a small pimple appears. Sometimes just the immediate area is swollen; other times, the entire eyelid swells. You may notice frequent watering in the affected eye, a feeling like something is in the eye or increased light sensitivity.

What causes styes?

Styes are caused by staphylococcal bacteria. This bacterium is often found in the nose, and it's easily transferred to the eye by rubbing first your nose, then your eye.

Treatment for styes

Most styes heal within a few days on their own. You can encourage this process by applying hot compresses for 10 to 15 minutes, three or four times a day over the course of several days. This will relieve the pain and bring the stye to a head, much like a pimple. The stye ruptures and drains, then heals.

Never "pop" a stye like a pimple; allow it to rupture on its own. If you have frequent styes, your eye doctor may prescribe an antibiotic ointment to prevent a recurrence.

Styes formed inside the eyelid either disappear completely or (rarely) rupture on their own. This type of stye can be more serious, and may need to be opened and drained by your eyecare practitioner.

Chalazion: Another type of eyelid bump

Often mistaken for a stye, a chalazion is an enlarged, blocked oil gland in the eyelid. A chalazion mimics a stye for the first few days, and then turns into a painless hard, round bump later on. Most chalazia develop further from the eyelid edge than styes.

Although the same treatment speeds the healing of a chalazion, the bump may linger for one to several months. If the chalazion remains after several months, your eye doctor may drain it or inject a steroid to facilitate healing.

To learn more about a stye, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Uveitis

Uveitis is inflammation of the eye's uvea, an area that consists of the iris, the ciliary body and the choroid. The iris is the colored part of the eye that surrounds the pupil. The ciliary body is located behind the iris and produces the fluid that fills the anterior part of the eye. The choroid is the layer of tiny blood vessels in the back of the eye that nourishes the light-sensitive retina.

Uveitis is classified by which part of the uvea it affects: Anterior uveitis refers to inflammation of the iris alone (called iritis) or the iris and ciliary body. Anterior uveitis is the most common form. Intermediate uveitis refers to inflammation of the ciliary body. Posterior uveitis is inflammation of the choroid. Diffuse uveitis is inflammation in all areas of the uvea.

Many cases of uveitis are chronic, and they can produce numerous possible complications that can result in vision loss, including cataracts, glaucoma and retinal detachment.

Uveitis signs and symptoms

Uveitis most commonly affects people in their 20s to their 50s. Signs and symptoms of uveitis include red eyes, pain, sensitivity to light, blurred vision and dark spots moving across your field of vision (floaters). These signs and symptoms may occur suddenly and worsen quickly.

If you experience any of these potential warning signs of uveitis, see your eye doctor immediately.

What causes uveitis?

The cause of uveitis is often unknown. However, in some cases, it has been associated with:

        Eye injuries.

        Inflammatory disorders, such as multiple sclerosis, Crohn's disease or ulcerative colitis.

        Viral infections, such as herpes simplex or herpes zoster.

        Autoimmune disorders, such as rheumatoid arthritis or ankylosing spondylitis.

        Other infections, including toxoplasmosis and histoplasmosis.

Uveitis treatment

To treat uveitis, your eye doctor may prescribe a steroid to reduce the inflammation in your eye. Whether the steroid is in eye drop, pill or injection form depends on the type of uveitis you have. Because anterior uveitis affects the front of the eye, it's easy to treat with eye drops. Intermediate uveitis can go either way, and posterior uveitis usually requires orally-administered medication or injections.

If an infection is suspected as the cause of your uveitis, your doctor may also prescribe additional medications to bring the infection under control. And if your uveitis has caused elevated intraocular pressure (IOP) in your eyes, drugs to reduce IOP to normal levels may also be used.

The duration of treatment for uveitis is often determined by the part of your eye that's affected. With proper treatment, anterior uveitis can clear up in a matter of days to weeks. Posterior uveitis, on the other hand, may require a much longer period of treatment before it is completely under control.

Episodes of uveitis can recur. See your eye doctor immediately if signs and symptoms of uveitis reappear after successful treatment.

For more information on uveitis and other eye conditions, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Sports Vision

Contacts and Glasses That Enhance Performance

Contacts and Glasses That Enhance Performance

Good vision is critical for nearly every sport. To determine the effect of visual acuity on sports performance, British optometrist Geraint Griffiths and others in 2003 tested the performance of Wimbledon tennis players and UK national clay pigeon shooting champions when their vision was blurred with special goggles. Overall, the tennis players and marksmen showed a 25% worsening of performance when their visual acuity was only slightly blurred by the goggles.

In addition to providing sharp vision, sports eyewear offers a number of additional benefits to help athletes and sports enthusiasts of all ages perform at their highest level:

Protection from impact-related injuries

No one can perform at their best during sports if they are worrying about an injury. Compared to regular eyewear, sports eyewear offers a primary benefit of superior impact resistance and eye protection.

According to the American Academy of Ophthalmology, more than 40,000 sports-related eye injuries occur annually in the United States, and approximately one-third of those affected are children.

Experts agree that many if not most of these injuries can be prevented with protective eyewear, such as safety goggles with polycarbonate lenses. Polycarbonate lenses are up to 10 times more impact-resistant than regular eyeglass lenses and can withstand impact from a ball or other projectile traveling at up to 90 miles per hour.

Contact lenses alone offer no protection from sports-related eye injuries, and regular eyeglasses designed for everyday wear are not strong enough nor are they designed to offer adequate eye protection during sports.

While safety eyewear should be considered for every activity that has the potential for eye injury, it is essential for the following sports: baseball, softball, basketball, hockey, football, handball, racquetball, squash, field hockey, lacrosse, soccer, swimming and pool sports, fishing, tennis and volleyball. Paintball "war games" are another activity for which safety eyewear is a must.

Protection from UV

Another danger during outdoor sports, even in winter, is ultraviolet (UV) radiation from the sun. Excessive exposure to UV rays has been associated with eye diseases such as cataracts and ocular tumors. You can also get a "sunburn" on your eye – called photokeratitis – which is very painful and can cause long-term damage to the cornea (the clear front surface of the eye).

Skiers should always wear tinted goggles or sports sunglasses that block 100% of the sun's UV rays, since these harmful rays are stronger at higher altitudes. UV also bounces off snow (even on cloudy days) to increase one's exposure. Anyone participating in outdoor water sports also needs UV protection, since UV rays reflect off bodies of water.

Some contact lenses offer UV protection. However, since contacts cover only the center part of your eye and can't do anything for uncovered areas, you should still wear UV-blocking sunglasses, preferably with a close-fitting, wraparound style. Wide-brimmed hats are also helpful to reduce exposure of your eyes and face to UV rays.

Color enhancement

In some lighting conditions, "keeping your eye on the ball" is not as easy as it sounds. Sports eyewear with special tints can help. Amber-colored "shooting glasses" are popular with hunters because they increase the contrast of birds, clay pigeons, etc. against an overcast sky. Companies have also introduced special tinted soft contact lenses that can increase the contrast and visibility of tennis balls and baseballs. These light-filtering lenses are different than regular tinted color contacts, which are tinted to change the color of your eyes, but don't affect the colors or contrast of objects you see.

Light control

Polarized sports sunglasses reduce glare from reflective surfaces, making them extremely beneficial for fishing and other water sports. They can also reduce glare from sunlight reflecting off a sandy beach or light-colored pavement, such as an outdoor basketball court.

Anti-reflective (AR) coating is another glare reducer. AR-coated sports glasses reduce lens reflections at night if you're playing under bright lights. AR coating is also a good idea for the back surface of sport sunglasses. It reduces glare from "bounce-back" reflections that occur when sunlight hits the back of your lenses.

Photochromic lenses are another way to control light for optimum visibility and performance. These lenses darken automatically outdoors in response to UV rays from the sun. They reduce the intensity of light reaching your eyes to a more comfortable level, and provide 100% UV protection at the same time.

Convenience and comfort

Many people choose to wear contact lenses for sports, even if they prefer eyeglasses at work and for other daily activities. Contact lenses offer unobstructed peripheral vision and more natural-appearing vision, with no unwanted changes in image sizes that eyeglasses can sometimes produce.

One-day disposable soft contact lenses are an excellent option for sports, because they don't require cleaning. You wear them just once, and then throw them away. This makes them especially attractive to someone who normally wears eyeglasses.

And because they are made of a soft, oxygen-permeable material, one-day soft lenses require little or no adaptation. So even if you haven't worn contact lenses for a week or longer, you can usually wear a pair of one-day disposable lenses comfortably for a full day of sports or other activities.

Remember, though contacts offer visual and other advantages over glasses for sports (you don't have to worry about them fogging up or falling off when you're perspiring, for example), you still need to wear protective eyewear over contact lenses to protect your eyes from injuries and/or UV damage.

For more information on protective eyewear, visit All About Vision®.

Protective Sports Eyewear

Today, sports eyewear can be spotted on almost anyone who picks up a ball, bat, racquet or stick — whether they play in the major leagues or the Little League. Fortunately, coaches, parents and players now realize that wearing protective eyewear for sports pays off in several ways. The risk of eye damage is reduced or eliminated, and the player's performance is enhanced by the fact that they see well. In fact, many clubs today do not permit their members to participate without wearing proper eye gear.

Initially, there was some resistance by children to "looking funny" when they wore protective eyewear. Today, sports goggles are an accepted part of everyday life, much the way bike helmets have become the norm. In addition, both children and adults like the image that wearing protective eyewear gives them: it shows they mean business on the playing field.

If you're not wearing protective eyewear, consider this...

Prevent Blindness America reports that hospital emergency rooms treat 40,000 eye injuries every year that are sports-related. Sports such as racquetball, tennis and badminton may seem relatively harmless, but they involve objects moving at 60 miles per hour or faster. During a typical game, a racquetball can travel between 60 and 200 miles per hour. Another potential danger is that the racquets themselves move at high speed in a confined space and often make contact with one another.

Flying objects aren't the only hazard. Many eye injuries come from pokes and jabs by fingers and elbows, particularly in games where players are in close contact with each other. Basketball, for example, has an extremely high rate of eye injury.

These are great reasons to wear protective eyewear. Another aspect has to do with performance. It used to be common for people with mild to moderate prescriptions to simply participate in sports without wearing their glasses or contacts. But sharp vision is a vital ingredient to performing well in nearly every sport, and participating in sports when you have less than 20/20 vision is counterproductive.

Features to look for

Prescription glasses, sunglasses and even on-the-job industrial safety glasses don't provide adequate protection for sports use. Sports goggles are made in a variety of shapes and sizes. Some are even designed to fit in helmets used for football, hockey and baseball. Sports goggles should allow the use of helmets when the sport calls for it.

Lenses in sports eyewear are usually made of polycarbonate. Since polycarbonate is such an impact-resistant lens material, it works well to protect eyes from fast-moving objects. Polycarbonate lenses also have built-in ultraviolet (UV) protection and are coated to be scratch resistant — valuable properties for outdoor sports.

Polycarbonate is the material of choice for sports lenses, but the eyewear frame plays just as important a role. Different sports require different types of frames, which has led to development of sport-specific frames. Sport frames are constructed of highly impact-resistant plastic or polycarbonate, and most come with rubber padding to cushion the frame where it comes in contact with your head and the bridge of your nose.

Some sports styles are contoured, wrapping slightly around the face. This type of goggle works well for biking, hang-gliding, and sailing. Contact lens wearers especially benefit from the wraparound style, which shields your eyes from wind and dust.

A note about handball goggles

At one time, handball goggles for those with no need for vision correction were simply goggles with small openings in place of lenses. It was eventually recognized that the high speed of handballs compressed the ball enough to protrude through the opening and cause serious eye damage. All goggles worn for handball and racquetball should include impact-resistant polycarbonate lenses for adequate protection during these sports.

Important fitting considerations

Sport goggles must be properly fit to the individual wearer. This is particularly important with children, because there is a temptation to purchase a larger goggle than what is needed today so the youngster has "room to grow." Some growing room is acceptable, since sports goggles are made to be somewhat flexible in their width adjustment. If the frames are oversize, however, they will not protect the way they were designed, leaving a potential for damage when there is impact to the head or the face. It's a risk not worth taking.

By the same token, permitting a youngster to continue wearing goggles that he or she has outgrown can be just as dangerous. First, the frames will be uncomfortable, tempting the child to take them off. Secondly, the frames may obstruct peripheral vision, leading to poor performance with a potential for impact from unseen sources to one side or another. Review the fit of your youngsters' sports eyewear each year to ensure that they are still providing proper protection and are fitting comfortably. Make sure the padding inside the sides of the goggle rests flush with the face and the eyes are centered in the lens area.

For more information on sports eyewear, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Scuba Diving Masks and Swim Goggles

Scuba Diving Masks and Swim Goggles

When they're in the water, swimmers and scuba divers who wear eyeglasses or contact lenses could benefit from prescription swim goggles.

These special types of sports eyewear require a prescription that is different from a regular eyeglasses prescription because of the unique characteristics of an underwater environment. Water itself acts as a magnifier, which is why fish in a tank or other underwater objects sometimes appear larger than they actually are. Since light travels and bends differently through water than it does through air, your eye care professional will need to modify your eyeglasses prescription so your underwater sports eyewear gives you the same clear vision your glasses provide on dry land.

Also, depending on the style of diving mask or swim goggles you choose, an adjustment to your prescription may be necessary because the corrective lenses may be positioned closer or farther from your eyes than the normal position of your eyeglass lenses. 

Scuba diving masks

Prescription lenses for scuba diving masks are available in one of two forms: either the entire front of the mask is a prescription lens, or corrective lenses are inserted separately between the mask and your eyes. If the dive mask comes with prescription lenses, they may be either custom-made for your vision correction needs, or they can come pre-made in a prescription for nearsightedness or farsightedness that is the same for both eyes.

Most people who require corrective lenses have a similar prescription for both eyes, so a dive mask with pre-made lenses will usually provide adequate vision for reading gauges and maneuvering around underwater. Even though pre-made prescription lenses don't correct astigmatism, most people who have astigmatism can function quite well with a spherical (meaning "without astigmatism") correction in the water.

Dive masks made with lenses designed specifically to your measurements and prescription are generally more expensive than their pre-made counterparts.

Some diving masks are designed to allow customized prescription lens inserts to be attached to the inside of the front of the mask. This option provides a more accurate vision correction. But, depending on the depth, temperature and type of water that you're in, fogging may be a bit more problematic with lens inserts.

If you're a contact lens wearer, however, you might benefit from a diving mask that allows prescription lens inserts because they provide the option of wearing or not wearing contacts. If you have the contact lenses in for a dive, there's no need for the prescription insert. If you go diving without your contacts on, you can put the prescription lens inserts in the mask for a clear underwater experience.

Because of the potential risk of contamination of contact lenses underwater, it's generally a better idea to dive and swim without them. Another option is to wear one-day disposable soft contacts, and discard them as soon as you're back on dry land.

Swim goggles

Swimming goggles are much smaller and fit closer to your eyes than a diving mask. They are designed to protect your eyes from the water and be sleek and unobtrusive at the same time, so as not to interfere with your speed and motion. A rubber or silicone seal surrounds the lenses to keep water away from your eyes.

As with dive masks, swim goggles are available with pre-made prescription lenses that are the same power for both eyes. Because swim goggles generally are used in a pool setting, these pre-made prescription lenses will usually provide adequate vision. However, custom-made prescription swimming goggles are also an option.

For more information on sports eyewear, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Shooting Glasses and Hunting Eyewear

Hunters and gun enthusiasts require eye protection, whether at a shooting range or in the woods. All firearms have a certain amount of recoil, and many shooting activities take place outdoors, where wind, sun, dust, tree branches and brush all can cause eye injuries.

Pre-made nonprescription sports goggles are usually acceptable if you don't require vision correction or if you wear contact lenses. Most of these goggles have a wraparound style to shield the eyes from wind and dust. However, lens quality can vary in pre-made goggles. Make sure the lenses are made of polycarbonate, which is the most impact-resistant material available.

Frame features to look for

If you need prescription lenses in order to focus well, or if you simply want to use the best shooting eyewear available, shooting glasses in styles similar to aviator sunglasses are always popular.

Eyewear designed specifically for shooters, however, has a few more features than the traditional aviator-shaped frame for everyday (or "dress") wear. Most importantly, the frame should be a safety-rated model, with a strong rim to hold the lenses in place. Some styles have a "sweat bar" that runs the width of the frame above the lenses to add more stability to the frame and keep it steady on the face. Others have special padding on the frame around the eyes to cushion the frame against your face in case the gun recoils too far.  It also helps to shield your eyes from wind and dust.

The temples of shooting glasses are often designed with spring hinges that allow the frame to flex without breaking when recoil occurs. Also popular are temples that wrap around the ear in the "cable" style to help keep the frame in place.

Adjustable nose pads are a good idea so the frame can be fit in the optimum position, and softer silicone pad materials provide additional comfort.

The frames of shooting glasses are constructed of any number of ophthalmic materials, including titanium and other metals, regular plastic and tough polycarbonate.

Choose the right lenses

Polycarbonate lenses with a scratch-resistant hard coat and built-in ultraviolet protection have been the lenses of choice for shooting glasses for many years. This lens material is highly impact-resistant to provide you with maximum "blow-back" and "bounce-back" protection. Recently, new lens materials have been developed that are also very impact-resistant.

Many nonprescription shooting glasses come with several pairs of interchangeable lenses for use under different lighting conditions. Prescription lenses can be made to order in whatever color you deem most appropriate.

Many shooters are comfortable in lenses that are yellow or orange. Lenses in these hues block haze and blue light and enhance the orange color of the target. The brighter yellow the lens color is, the better it is for use in foggy or low-light conditions.

Alternatively, a light purple color, which is actually a combination of a neutral gray and vermilion, is good for enhancing the orange of the target against a background of tall trees. Vermilion itself is useful to highlight conditions where there is poor background, such as trees, and to enhance the target against the background. Gray is a neutral, or "true," color that lets you see all colors as they are. Gray shooting lenses do not enhance the target, but they are good in bright sunlight.

Polarized shooting lenses can be made in almost any color. Polarized lenses reduce glare from light bouncing off highly reflective surfaces, making them an excellent choice when hunting near bodies of water.

For more information on protective eyewear, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

What Sports Vision Doctors Can Do for You?

Seeing "20/20" isn't the only measure of good vision. Visual acuity (20/20, etc.) is certainly important. But good vision involves a set of several skills, including depth perception, peripheral visual field awareness, eye-hand coordination and more.

All these vision skills are extremely important in sports, whether you play golf, soccer, baseball, basketball or racquet sports.

If you want to perform your best in sports, you may benefit from seeing an eyecare practitioner who specializes in sports vision — even if you already have 20/20 vision. This is because a typical eye exam usually doesn't include tests of visual skills important to sports performance.

Sports vision testing is more extensive, and can be tailored to the specific sport you are interested in. During a sports vision exam, it's not unusual for the examiner to include tests to evaluate how well you see while you are moving around outdoors and interacting with other objects or players.

Many professional athletes work on their sports vision, but so do high school and college athletes, recreational golfers, tennis players and even billiards players. Some non-sports professionals also benefit from the same vision training, including law enforcement personnel and pilots.

When you visit a sports vision specialist, he or she will probably give you a complete eye exam and will ask you questions about your activities. More testing will determine your sports-related needs. These tests may include the use of three-dimensional, holographic images so you can react to them as in real life, and computerized tests that measure your reaction time and eye-hand coordination.

Depending on your particular sport, actual on-field measuring of your reactions to various sports situations may be included. Many sports vision specialists will attend your games or matches to help them evaluate your vision performance. They may also study videos of your games.

You may need only one visit to a specialist to set you on your way to better visual skills for sports. However, in many cases, a comprehensive sports vision training program is a better option to help you develop your sports vision skills so they become second nature.

For more information on sports vision, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Sunglasses

Nonprescription Sunglasses

Fashion sunglasses with nonprescription lenses are called "plano" sunglasses in the eyewear industry. This category of sunglasses is huge and offers many choices in styling, designer names and frame materials.

Part of the popularity of nonprescription sunglasses is due the fact that over 30 million Americans wear contact lenses. Anyone who wears contacts needs plano sunglasses to protect their eyes from the sun's harmful UV rays. Sunglasses help keep contacts from drying out when outdoors, and shield the eyes from windblown debris.

And, of course, sunglasses just look cool!

Fashion trends

Shapes and styles of plano sunglasses for men and women for the past few seasons have run the gamut: sporty wraparounds, glamorous cat-eyes and "Jackie Os," sleek futuristic styles that hug the face, small retro-looking shapes, large and sometimes bulbous "bubble" wraps, rectangular and angular styles, and even styles embellished with jewels.

Modern styles that have been popular recently, such as sleek wraps and Jackie O shapes, are given fresh energy with details like rhinestones and faux diamonds made of cubic zirconium. Lenses are tinted in a variety of colors, including blue, yellow, rose, orange, purple, black and coral.

Rimless and semi-rimless plano sunglasses (which have lenses held in place by a wire or plastic thread) are carrying some very unique lens shapes, cut in unusual angles. Additionally, some plastic sunglass frames are featuring cut-outs and other details to give them a more distinctive look.

Sunglass materials

Options for frame materials used in nonprescription sunglasses include plastic (often called "zyl"), and premium metals such as titanium, stainless steel, aluminum and beryllium. These metals are strong yet very lightweight for comfort, and are also hypoallergenic and corrosion-resistant.

Many sunwear styles today incorporate both metal and plastic into the frame design, giving them a unique look.

Shopping for sunglasses

When you shop for sunglasses, first make sure the frame fits comfortably on your face. Just like when buying prescription eyeglasses, follow these tips to make sure you have a good fit:

    Choose frames that are wide enough for your face. The edge of the frames should protrude slightly beyond your face so the temples don't put pressure on your head as they extend back to your ears.

    Are the temples long enough? The curve at the end of the temple should extend over your ear without pressing down upon it. (Some styles have straight temples that don't curve around the ear.) 

    Check the nosepiece for comfort and fit. The frame should fit securely without pinching the bridge of your nose.

    While wearing the sunglasses, move your head up and down, and bend over (as if to pick up something up from the floor). If they're fitting properly, the sunglasses should stay comfortably in place.

The color and shape of the frame you choose depends on your personal style and preference. Don't be afraid to go bold – plano sunglasses are as much a fashion statement as they are a form of eye protection.

Choosing the right lenses

Make sure the lenses block 100 percent of the sun's harmful UV rays. Sunglasses don't have to be expensive to provide this level of protection.

If you plan on wearing the sunglasses for sports, choose styles with lightweight, impact-resistant polycarbonate lenses for an extra margin of safety.

For more information on sunglasses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Performance and Sport Sunglasses

The boom in outdoor sports activities like mountain biking, snowboarding, rock climbing, kayaking, skiing, golfing and in-line skating has also created a demand for sports- and performance-oriented sunglasses.

These special-purpose sunglasses are designed to be exceptionally light and comfortable, able to withstand extreme conditions and stay comfortably in place during any activity.

Lenses

Perhaps the most important aspect of effective sports sunwear is the optical quality and visual enhancement properties of the lenses. In particular, sports and performance lenses are available in a wide variety of tints to modify light in certain ways to enhance contrast. This allows you to see certain objects (a tennis ball, for example) with greater clarity to enhance your reaction time.

Polycarbonate lenses are the lens of choice for most sport sunglasses because they are lightweight, super strong and more impact-resistant than lenses made of other materials.

Polarized lenses are also in demand, because they reduce glare from light reflecting off flat surfaces such as water or a field of snow. There is, however, some debate about the advisability of polarized lenses for sports like downhill and mogul skiing, since seeing sunlight reflecting from icy patches on the slopes is often beneficial.

Frames

The frames for performance and sport sunglasses are made of lightweight and durable materials such as polyamide, which keeps its shape even under stress. Styles are typically aerodynamic, with sleek lines. No-slip temple grips and nose pads are popular features to help keep the eyewear in place despite wearer perspiration during the heat of competition.

What's your sport?

Each sport has its own unique visual requirements, which has led to the development of sport-specific sunglasses. Frames and lenses are now available that are targeted specifically to the golfer, the cyclist, the boater, the rock climber and so on.

For example, a certain lens tint might help a golfer notice subtle changes in the direction of the blades of grass on a green that could affect the line of their putt, while a completely different tint might be better to help a hunter see the contrast of a flying bird against an overcast sky.

If you prefer to be a Jack (or Jill) of all sports, there are also multipurpose sports sunglasses that feature interchangeable lenses with different tints for different sports and lighting conditions.

For more information on sport sunglasses and polarized sunglasses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Prescription Sunglasses

If you currently wear eyeglasses for nearsightedness, farsightedness or astigmatism, you should strongly consider purchasing a second pair of glasses: prescription sunglasses.

Why? Because prescription sunglasses are often the best solution when you want clear, comfortable vision outdoors or when you're driving on a sunny day. They eliminate glare and the need for squinting in bright conditions, which can reduce vision and cause eye strain.

Even if you normally wear contact lenses and nonprescription (plano) sunglasses, there will be times when your contacts dry out or become uncomfortable – especially on the beach, where you battle the effects of sand, sun, wind and water. Prescription sunglasses enable you to be outdoors all day without these discomfort problems or the hassle of dealing with your contacts.

A better solution for driving

If you normally wear prescription eyeglasses, you face a dilemma when driving on sunny days. You can purchase "clip-on" sunglasses (or a modern magnetic version of them) for your eyeglasses. But these can sometimes scratch your lenses or can be difficult to put on without taking off your glasses – which can be dangerous when driving.

Another solution is to purchase one pair of prescription eyeglasses that have photochromic lenses – the kind that darken automatically outdoors. The problem here is that these lenses often won't darken properly inside a vehicle because some of the sun's UV rays are blocked by your car or truck's windshield glass.

For convenience and comfort, the best solution for seeing in the sun is prescription sunglasses. For easy access and so you don't forget them, store them in your car or boat so they're always there when you need them.

Many lens styles available

Prescription sunglasses are available in a wide variety of lens materials and designs, including high index plastic and progressive ("no-line bifocal") lenses. For boating, fishing and driving, polarized lenses offer superior glare protection from light reflecting off water and roadways.

If you plan on wearing your prescription sunglasses when playing sports, working with power tools or engaging in other activities that have the potential of causing eye injuries, choose lightweight lenses made of polycarbonate or Trivex. Lenses made of these materials are far more impact-resistant than glass or plastic sunglass lenses.

As with regular prescription eyeglasses, frame styles for prescription sunglasses are nearly unlimited. The only exception is that prescription sunglasses cannot be made in the same severe wraparound styles that some nonprescription sunglasses have. However, models with a lesser-curved wraparound style are available.

For more information on prescription sunglasses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Sunglasses for Kids

Children may not be as interested as adults are in wearing sunglasses as a fashion accessory. But because kids spend so much time outdoors in direct sunlight, they need sun protection even more than adults.

In fact, some experts say we get up to 80 percent of our lifetime exposure to solar ultraviolet (UV) radiation by the time we're 18 years old.

Many styles available

You should have no trouble finding sunglasses your child will enjoy wearing. Children's sunglasses are available in a wide variety of styles and sizes. And virtually any children's frame can be transformed into sunglasses by adding prescription or non-prescription sun lenses.

Metal frames are very popular for children's sunglasses because of their durability. Wraparound styles like those worn by adults are also popular in scaled-down versions for kids. Because they fit closer to the face than traditional frame styles, wraparound sunglasses provide superior UV protection for not only for your child's eyes, but for the delicate skin around their eyes as well.

Choose lenses with 100% UV protection

The most important thing when choosing children's sunglasses is to make sure the lenses block 100% of the sun's ultraviolet (UV) rays. The harmful effects of UV radiation are cumulative over our lifetime. By limiting your youngster's exposure to UV rays during childhood, you may be decreasing their risk of cataracts and other eye problems when they become adults.

Polycarbonate lenses are great for kids' sunglasses because they have 100% UV protection built-in, and they are lighter and much more impact-resistant than lenses made of other materials. And they can be tinted to nearly any shade.

Photochromic polycarbonate lenses are a good choice for kids who need prescription eyewear. These lenses darken automatically when exposed to the sun's UV rays, and then quickly return to a clear state indoors – so one pair of eyeglasses does the job of two! They also provide 100% UV protection.

Don't forget the accessories!

To protect your investment in your child's sunglasses, purchase a durable, hard-shell carry case for them. Also, make sure your son or daughter knows how to clean and care for their eyewear. Getting sunglass cords (commonly called "retainers") is also a good idea. These are attached to the temples of the frame so your child can remove their sunglasses and the eyewear will stay with them – hanging from their neck instead of getting misplaced.

For more information on children's sunglasses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Vision Insurance

What Is Vision Insurance?

The cost of routine eye exams and prescription eyewear can be of real concern, especially for large families. In many cases, vision insurance can lower these annual expenses.

A vision insurance policy is not the same as health insurance. Regular health insurance plans protect you against financial losses due to unexpected eye injuries or disease. Vision insurance, on the other hand, is a wellness benefit designed to provide routine eye care, prescription eyewear and other vision-related services at a reduced cost.

Where can I get vision insurance?

Group vision insurance can be obtained through your company, association, school district, etc., or through a government program such as Medicare or Medicaid.

Also, as an individual, you have the option of purchasing your own vision benefit plan.

Vision insurance is often a value-added benefit included in indemnity health insurance plans, health maintenance organization (HMO) plans and plans offered by preferred provider organizations (PPOs):

  • Indemnity health insurance is traditional insurance, which allows policyholders to access medical providers of their choice.
  • An HMO is a group of healthcare professionals – doctors, laboratories, hospitals and the like – employed to provide health care services to plan members at discounted rates. Usually, health plan members are required to access health care only from HMO providers.
  • A PPO is a network of healthcare professionals organized to provide healthcare services to plan members at a fixed rate below "retail" prices. Plan members may opt to access out-of-network providers, but usually at a greater cost.

What kinds of vision insurance plans are available?

Vision insurance typically comes in the form of either a vision benefits package or a discount vision plan.

Typically, a vision benefits package provides enrollees eye care services in exchange for an annual premium or membership fee, a yearly deductible (a dollar amount) for each enrolled member and a co-pay (a smaller dollar amount) each time a member accesses a service.

A discount vision plan provides eye care at fixed discounted rates after an annual premium or membership fee and a deductible are paid.

Both kinds of vision insurance can be custom-designed to meet the different requirements of a wide range of customers, including school districts, unions, and big and small companies.

What does vision insurance cover?

Vision insurance generally covers the following services and products:

  • Annual eye examinations
  • Eyeglass frames
  • Eyeglass lenses
  • Contact lenses
  • LASIK and PRK vision correction at discounted rates

Generally, services acquired from network providers are cheaper than services from out-of-network providers.

What are my payment options?

Typically, if group vision insurance is available from your employer, you pay for it through payroll deductions or flexible spending accounts (FSAs).

An FSA, sometimes called a cafeteria plan, allows an employee to use pre-tax dollars to purchase selected health benefits such as vision insurance. You save money because you receive the full benefit of income that has been set aside for health costs, making it not subject to or reduced by taxation.

If you purchase an individual vision insurance plan because your employer doesn't offer a group plan (or because you are self-employed), you can expect to be billed monthly or annually.

For more information on vision insurance, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Vision Over 40

Dry Eye After Menopause

Studies show that more than 14% of older Americans have dry eye syndrome, or "dry eye." If you are 50 or older and female, your chance of developing dry eye is even greater. In fact, the American Academy of Ophthalmology says hormonal changes make older women twice as likely as older men to develop dry eye and accompanying symptoms such as eye irritation and blurred vision.

Women who have undergone menopause may experience disrupted chemical signals that help maintain a stable tear film. Resulting inflammation also can lead to decreased tear production and dry eye. Some theories indicate that a decline in a hormone known as androgen could be an underlying cause of dry eye in older women.

What Can You Do if You Are Older and Develop Dry Eye?

While levels of the female hormone estrogen also decrease following menopause, studies have not shown any beneficial effect of estrogen hormone replacement therapy (HRT) in relieving dry eye.

If you are over age 40 and have been diagnosed with dry eye, you may want to avoid laser vision correction surgery. Procedures such as LASIK and PRK can permanently affect nerve function of your eye's clear surface (cornea) and worsen dry eye problems. If you choose to have a refractive surgery consultation, be sure to tell your examining eye doctor about your dry eye condition. Your doctor can perform special tests to determine if your eyes are moist enough for laser vision correction.

If you have already been diagnosed with dry eyes, make sure you are being appropriately treated for other conditions associated with both aging and dry eye such as rheumatoid arthritis and thyroid autoimmune disease.

Also, keep in mind that many medications required by adults over age 40 may cause or worsen dry eye problems. Examples include diuretics (often prescribed for heart conditions) and antidepressants. If you suspect a medication may be the underlying cause of your dry eye, be sure to discuss this with your doctor. It's possible that changing to a different medical treatment may be equally effective without causing dry eye problems. Also, concurrent treatment of your dry eye may be necessary.

Finally, it's possible that allergies or other problems that cause eye inflammation may be the underlying cause of your dry eye symptoms. Your eye doctor may recommend over-the-counter or prescription eye drops to relieve both your eye allergies and inflammatory dry eye problems.

For more information on treating dry eyes, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

How Progressive Lenses Work?

Progressive addition lenses (also called progressives or PALs) are the most popular multifocal lenses sold in the United States. Sometimes called "no-line bifocals," these line-free multifocals provide a more complete vision solution than bifocals. Instead of having just two lens powers like a bifocal – one for distance vision and one for up close – progressives have a gradual change in power from the top to the bottom of the lens, providing a range of powers for clear vision far away, up close and everywhere in between.

Progressive lenses provide the closest thing to natural vision after the onset of presbyopia – the normal age-related loss of near vision that occurs after age 40. The gradual change of power in progressives allows you to look up to see in the distance, look straight ahead to clearly see your computer or other objects at arm's length, and drop your gaze downward to read and do fine work comfortably close up.

While progressive lenses typically are worn by middle-aged and older adults, a recent study suggests that they may also be able to slow progression of myopia in children whose parents also are nearsighted.

Choosing the right frame for progressive lenses

Because a progressive lens changes in power from top to bottom, these lenses require frames that have a vertical dimension that is tall enough for all powers to be included in the finished eyewear. If the frame is too small, the distance or near zone of the progressive lens may end up too small for comfortable viewing when the lens is cut to fit into the frame.

To solve this problem and to expand options in frame styles, most progressive lens manufacturers now offer "short corridor" lens designs that fit in smaller frames. Today, an experienced optician can usually find a progressive lens that will work well in nearly any frame you choose.

Different progressives for different purposes

Many different progressive lenses are available on the market today, and each has its own unique design characteristics. There are even progressive lenses designed for specific activities. For example, for the computer user, special "occupational" progressive lenses are available with an extra-wide intermediate zone to maximize comfort when working at the computer for prolonged periods of time. Other designs for office work have a larger reading portion.

Adaptation

It may take a few minutes to a few days before you are completely comfortable with your first pair of progressive lenses, or when you change from one progressive lens design to another. You have to learn how to use the lenses, so you are always looking through the best part of the lens for the distance you are viewing. You also may notice a slight sensation of movement when you quickly move your eyes or your head until you get used to the lenses. But for most wearers, progressive lenses are comfortable right from the start.

Let us help

With so many options in eyewear today, choosing the right frame and lenses can seem overwhelming. Let us help. Our professional opticians can discuss the advantages of the latest progressive lenses with you and help you find the lenses and frames that best match your needs.

For more information on progressive lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Multifocal Contact Lenses

Once we reach our mid-40s, presbyopia – the normal, age-related loss of flexibility of the lens inside our eye – makes it difficult for us to focus on near objects. In the past, reading glasses were the only option available to contact lens wearers who wanted to read a menu or do other everyday tasks that require good near vision.

But today, a number of multifocal contact lens options are available for you to consider. Multifocal contact lenses offer the best of both worlds: no glasses, along with good near and distance vision.

Types of multifocal contact lenses

Some multifocal contact lenses have a bifocal design with two distinct lens powers – one for your distance vision and one for near. Others have a multifocal design somewhat like progressive eyeglass lenses, with a gradual change in lens power for a natural visual transition from distance to close-up.

Multifocal contacts are available in both soft and rigid gas permeable (RGP or GP) lens materials and are designed for daily wear or extended (overnight) wear. Soft multifocal lenses can be comfortably worn on a part-time basis, so they're great for weekends and other occasions if you prefer not to wear them on an all-day, every day schedule.

For the ultimate in convenience, one-day disposable soft multifocal lenses allow you to discard the lenses at the end of a single day of wear, so there's no hassle with lens care.

In some cases, GP multifocal contact lenses provide sharper vision than soft multifocals. But because of their rigid nature, GP multifocal contacts require some adaptation and are more comfortable if you condition your eyes by wearing the lenses every day.

Hybrid multifocal contacts are an exciting new alternative. These lenses have a GP center and a soft periphery, making it easier to adapt.

Astigmatism? No problem.

All types of multifocal contact lenses – GP, soft, and hybrid – are available to correct astigmatism at the same time as presbyopia.

Monovision

Until you have a contact lens fitting, there's no way to know for sure if you'll be able to successfully adapt to wearing multifocal contact lenses. If multifocal lenses aren't comfortable or don't give you adequate vision, a monovision contact lens fitting may be a good alternative.

Monovision uses your dominant eye for distance vision and the non-dominant eye for near vision. Right-handed people tend to be right-eye dominant and left-handed folks left-eye dominant. But your eye care professional will perform testing to make that determination.

Usually, single vision contact lenses are used for monovision. One advantage here is that single vision lenses are less costly to replace, lowering your annual contact lens expenses. But in some cases, better results can be achieved using a single vision lens on the dominant eye for distance vision and a multifocal lens on the other eye for intermediate and near vision. Other times, your eyecare professional may choose a distance-biased multifocal on your dominant eye and a near-biased multifocal on the other eye. These techniques are referred to as "modified monovision" fits.

For more information on monovision or multifocal contact lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Multifocal Eyeglass Lenses

Just as eyeglass frames have continually changed to reflect the latest fashions, eyeglass lenses also have evolved. This is particularly true for multifocal lenses – eyeglass lenses with more than one power to help those of us over age 40 deal with the normal, age-related loss of near vision called presbyopia.

History of multifocal eyeglass lenses

Benjamin Franklin, the early American statesman and inventor, is credited with creating the first multifocal eyeglass lenses. Prior to Franklin's invention, anyone with presbyopia had to carry two pairs of eyeglasses – one for seeing distant objects and one for seeing up close.

Sometime around 1780, Franklin cut two lenses in half (one with a distance correction and one with a correction for near) and glued them together, so the top half of the new lens enabled the wearer to see things far away and the bottom half helped them see up close.

This lens, with a line extending across the entire width of it, was first called the Franklin bifocal and later became known as the Executive bifocal.

Modern multifocal lenses

Bifocals. There have been many changes to bifocal eyeglass lenses since Franklin's original design, making these two-power lenses thinner, lighter and more attractive. Today, the most popular bifocal for eyeglasses is called a flat-top (FT) or straight-top (ST) design. The part that contains the power for near vision is a D-shaped segment (or "seg") in the lower half of the lens that is rotated 90 degrees so the flat part of the "D" faces upward.

FT or ST bifocals (sometimes also called a D-seg bifocals), are available in different-sized near segments. The most popular version sold in the United States has a near segment that is 28 millimeters wide, and is therefore called the ST-28 (or FT-28 or D-28) bifocal. This design offers a generous field of view for reading, yet keeps the near seg small enough to be cosmetically pleasing.

Other available bifocal designs include lenses with round near segments and bifocals where the near seg extends across the entire width of the lens (Executive bifocals).

All bifocals, however, have a limitation: Though they provide good vision for distance and near, they can leave the wearer's intermediate vision (for distances at arm's length) blurry. Which brings us to…

Trifocals. Trifocal eyeglass lenses have an additional ribbon-shaped lens segment immediately above the near seg for seeing objects in the intermediate zone of vision – approximately 18 to 24 inches away.

This intermediate segment provides 50% of the magnification of the near seg, making it perfect for computer use and for seeing your speedometer and other dashboard gauges when driving.

Trifocals are especially helpful for older presbyopes – those over age 50 – who have less depth of focus than younger presbyopes. (Younger presbyopes may still be able to see objects at arm's length reasonably well through the top part of their bifocals.)

As with bifocals, the most popular trifocals have a flat-top (FT) design, with the near and intermediate segments being 28 mm wide. Trifocals with 35 mm wide segments are also popular.

Limitations of bifocals and trifocals

Although bifocals and trifocals are very functional, they pose a problem – the visible lines in the lenses. Most people prefer not to advertise their age by wearing multifocal eyeglass lenses with lines in them that everyone can see.

The lines in bifocals and trifocals cause a vision problem as well. Because they mark well-defined changes in power within the lenses, as the wearer's eyes move past the lines, there is an abrupt change in how objects appear. This "image jump" can be difficult for some wearers to adapt to.

Some years ago, these limitations of conventional bifocals and trifocals led to a major breakthrough in multifocal eyeglass lens design: progressive lenses.

Progressive multifocal lenses

Progressive multifocal lenses (also called progressives, progressive addition lenses, and PALs) are true "multi-focal" lenses. Instead of having just two or three powers, progressives gradually change in power from the top to the bottom of the lens, offering a large number of powers for clear vision at all distances – distance, intermediate, near and everywhere in between.

And because there are no visible lines or abrupt changes of lens power in progressive lenses, there is no "image jump," so the wearer's vision generally is more comfortable and seems more natural.

Because of these advantages, progressive lenses have become the most popular multifocal lenses sold in the United States.

The right multifocal lenses for you

The right multifocal lenses for you will depend on your age, your visual needs, your budget and other factors. Visit us today for more information about bifocal, trifocal, and progressive lenses and to get a customized solution to your vision and eyewear needs.

For more information on eyeglass lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Occupational Bifocals and Trifocals

An occupational lens is a type of multifocal that is specifically suited for performing a particular job or hobby. Glasses with these lenses are special-purpose eyewear and are not designed for everyday wear.

The Double-D Bifocal: For reading and overhead near work

The Double-D is an occupational bifocal which consists of a D-shaped flat-top bifocal at the bottom of the lens and an upside-down flat-top near segment located at the top of the lens. The rest of the lens area consists of distance correction.

People in occupations such as auto maintenance and repair would benefit from a Double-D occupational bifocal. This design allows workers to be able to see well up-close, both when looking down and when looking up to work on the undercarriage of a car on a lift. Mail clerks and others who read documents and may need to file them overhead might also find this lens useful at work.

The E-D Trifocal: For when you need to see everywhere, but especially at arm's length

The E-D trifocal has the distance correction in the top half of the lens and an intermediate correction for vision at arm's length in the bottom half of the lens. The line separating these two zones extends across the entire width of the lens, like an Executive bifocal. But in the E-D trifocal, a small D-shaped segment for near vision is embedded within the intermediate zone.

The E-D trifocal is an excellent choice for someone who needs a wide field of view at arm's length, but also needs to see clearly close up and in the distance. A television production person, who must keep an eye on several TV monitors while being able to read notes from a clipboard and recognize someone across the room, would be a good candidate for this lens.

Need to read all day at work?

Sometimes, a common multifocal can become an occupational lens simply by changing the position of the intermediate or near segment or the characteristics of the progressive design.

For example, if your job requires you to read much of your day, you may want to consider a separate pair of glasses for work that have the bifocal or trifocal segments placed higher-than-normal in the lens. This would enable you to read or use your computer for extended periods without having to tip your head back in an uncomfortable posture.

Or you may want to try an "office" progressive lens, which has a larger, wider intermediate zone for computer use, and a smaller zone for distance vision. These occupational lenses give your more usable vision for your computer and desk work, yet still provide adequate distance vision for spotting people across the room. However, because the distance zone of occupational progressive lenses is limited, they're not suitable for driving or for other tasks that require a wide field of view in the distance.

What about on the golf course?

If you're a golfer and wear multifocal lenses, you know these lenses can be a problem on the course. The near vision zones of bifocal, trifocal and progressive lenses can interfere with your view of the ball, requiring you to tilt your head down in an uncomfortable posture. Everyday multifocals can also make lining up a putt much more difficult.

The solution? Consider trying an occupational multifocal commonly called a "golfer's bifocal." The small (usually round) near segment is placed very low and in the outside corner of just one lens, so it's completely out of the way when you address your ball or line up a putt. But it still gives you enough near vision to read your scorecard or browse a menu for lunch in the clubhouse.

Customized eyewear solutions

Nearly all adults – especially anyone over age 40 who needs multifocal lenses – can benefit from having more than one pair of eyeglasses, with the second pair having an occupational design.  Visit us today to explore your many options for eyewear solutions that are specifically tailored to your vision needs.

For more information on eyeglass lenses, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Vision Over 60

Eight Ways To Protect Your Eyesight

Sight-threatening eye problems affect one in six adults aged 45 and older. And the risk for vision loss increases with age. In fact, a recent American Academy of Ophthalmology (AAO) report estimates that more than 43 million Americans will develop age-related eye diseases by the year 2020.

Tips for protecting your eyes

To protect your eyesight and keep your eyes healthy as you age, consider these simple guidelines:

  1. Be aware of your risk for eye diseases. Find out about your family's health history. Do you or any of your family suffer from diabetes or have high blood pressure? Are you over the age of 65? Are you an African-American over the age of 40? Any or all of these traits increase your risk for sight-threatening eye diseases. Regular eye exams can detect problems early and help preserve your eyesight.
     
  2. Have regular exams to check for diabetes and high blood pressure. If left untreated, these diseases can cause eye problems. In particular, diabetes and high blood pressure can lead to diabetic retinopathy, macular degeneration, glaucoma and ocular hypertension.
     
  3. Look for changes in your vision. If you start noticing changes in your vision, see your eye doctor immediately. Trouble signs include double vision, hazy vision and difficulty seeing in low light conditions. Other signs to look for are frequent flashes of light, floaters, and eye pain and swelling. All of these signs and symptoms can indicate a potential eye health problem that needs immediate attention.
     
  4. Exercise more frequently. According to the AAO, some studies suggest that regular exercise – such as walking – can reduce the risk of macular degeneration by up to 70%.
     
  5. Protect your eyes from the sun's UV rays. You should always wear sunglasses with proper UV protection to shield your eyes from the sun's harmful rays. This may reduce your risk of cataracts and other eye damage.
     
  6. Eat a healthy and balanced diet. Numerous studies have shown that antioxidants can possibly reduce the risk of cataracts. These antioxidants are obtained from eating a diet containing plentiful amounts of fruits and colorful or dark green vegetables. Studies have also shown that eating fish rich in omega-3 fatty acids may also prevent macular degeneration.
     
  7. Get your eyes checked at least every two years. A thorough eye exam, including dilating your pupils, can detect major eye diseases such as diabetic retinopathy, which has no early warning signs or symptoms. A comprehensive eye exam also can ensure that your prescription for eyeglasses or contact lenses is accurate and up-to-date.
     
  8. Don't smoke. The many dangers of smoking have been well documented. When it comes to eye health, people who smoke are at greater risk of developing age-related macular degeneration and cataracts.

Following these steps is no guarantee of perfect vision throughout your lifetime. But maintaining a healthy lifestyle and having regular eye exams will certainly decrease your risk of sight-stealing eye problems and help you enjoy your precious gift of eyesight to the fullest. 

For more information on eye exams and eye vitamins, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

How Your Vision Changes as You Age?

Just as our physical strength decreases with age, our eyes also exhibit an age-related decline in performance – particularly as we reach our 60s and beyond.

Some age-related eye changes, such as presbyopia, are perfectly normal and don't signify any sort of disease process. While cataracts can be considered an age-related disease, they are extremely common among seniors and can be readily corrected with cataract surgery.

Some of us, however, will experience more serious age-related eye diseases that have greater potential for affecting our quality of life as we grow older. These conditions include glaucoma, macular degeneration and diabetic retinopathy.

When do age-related vision changes occur?

Presbyopia. After you pass the milestone age of 40, you'll notice it's more difficult to focus on objects up close. This normal loss of focusing ability is called presbyopia, and is due to hardening of the lens inside your eye.

For a time, you can compensate for this decline in focusing ability by just holding reading material farther away from your eyes. But eventually, you'll need reading glasses, multifocal contact lenses or multifocal eyeglasses. Some corrective surgery options for presbyopia also are available, such as monovision LASIK and conductive keratoplasty (CK).

Cataracts. Even though cataracts are considered an age-related eye disease, they are so common among seniors that they can also be classified as a normal aging change. According to Mayo Clinic, about half of all 65-year-old Americans have some degree of cataract formation in their eyes. As you enter your 70s, the percentage is even higher. It's estimated that by 2020 more than 30 million Americans will have cataracts.

Thankfully, modern cataract surgery is extremely safe and so effective that 100% of vision lost to cataract formation usually is restored. If you are noticing vision changes due to cataracts, don't hesitate to discuss symptoms with your eye doctor. It's often better to have cataracts removed before they advance too far. Also, multifocal lens implants are now available. These advanced intraocular lenses (IOLs) potentially can restore all ranges of vision, thus reducing your need for reading glasses as well as distance glasses after cataract surgery.

Major age-related eye diseases

Macular degeneration. Macular degeneration (also called age-related macular degeneration or AMD) is the leading cause of blindness among American seniors. According to the National Eye Institute (NEI), macular degeneration affects more than 1.75 million people in the United States. The U.S. population is aging rapidly, and this number is expected to increase to almost three million by 2020. Currently, there is no cure for AMD, but medical treatment may slow its progression or stabilize it.

Glaucoma. Your risk of developing glaucoma increases with each decade after age 40 – from around 1% in your 40s to up to 12% in your 80s. The number of Americans with glaucoma is expected to increase by 50% (to 3.6 million) by the year 2020. If detected early enough, glaucoma can often be controlled with medical treatment or surgery and vision loss can be prevented.

Diabetic retinopathy. According to the NEI, approximately 10.2 million Americans over age 40 are known to have diabetes. Many experts believe that up to 30% of people who have diabetes have not yet been diagnosed. Among known diabetics over age 40, NEI estimates that 40% have some degree of diabetic retinopathy, and one of every 12 people with diabetes in this age group has advanced, vision-threatening retinopathy. Controlling the underlying diabetic condition in its early stages is the key to preventing vision loss.

How aging affects other eye structures

While normally we think of aging as it relates to conditions such as presbyopia and cataracts, more subtle changes in our vision and eye structures also take place as we grow older. These changes include:

  • Reduced pupil size. As we age, muscles that control our pupil size and reaction to light lose some strength. This causes the pupil to become smaller and less responsive to changes in ambient lighting.
     
    Because of these changes, people in their 60s need three times more ambient light for comfortable reading than those in their 20s. Also, seniors are more likely to be dazzled by bright sunlight and glare when emerging from a dimly lit building such as a movie theater. Eyeglasses with photochromic lenses and anti-reflective coating can help reduce this problem.
     
  • Dry eyes. As we age, our bodies produce fewer tears. This is particularly true for women after menopause. If you begin to experience burning, stinging or other eye discomfort related to dry eyes, use artificial tears as needed throughout the day for comfort, or consult your eye doctor for other options such as prescription dry eye medications.
     
  • Loss of peripheral vision. Aging also causes a normal loss of peripheral vision, with the size of our visual field decreasing by approximately one to three degrees per decade of life. By the time you reach your 70s and 80s, you may have a peripheral visual field loss of 20 to 30 degrees.

Because the loss of visual field increases the risk for automobile accidents, make sure you are more cautious when driving. To increase your range of vision, turn your head and look both ways when approaching intersections. 

  • Decreased color vision. Cells in the retina that are responsible for normal color vision decline in sensitivity as we age, causing colors to become less bright and the contrast between different colors to be less noticeable. In particular, blue colors may appear faded or "washed out." While there is no treatment for this normal, age-related loss of color perception, you should be aware of this loss if your profession (for example, artist, seamstress or electrician) requires fine color discrimination.
     
  • Vitreous detachment. As we age, the gel-like vitreous inside the eye begins to liquefy and pull away from the retina, causing "spots and floaters" and (sometimes) flashes of light. This condition, called vitreous detachment, is usually harmless. But floaters and flashes of light can also signal the beginning of a retinal detachment – a serious problem that can cause blindness if not treated immediately. If you experience flashes and floaters, see your eye doctor immediately to determine the cause.

What you can do about age-related vision changes

A healthy diet and wise lifestyle choices – including exercising regularly, maintaining a healthy weight, reducing stress and not smoking – are your best natural defenses against vision loss as you age. Also, have regular eye exams with a caring and knowledgeable optometrist or ophthalmologist.

Be sure to discuss with your eye doctor all concerns you have about your eyes and vision. Tell them about any history of eye problems in your family and any health problems you may have. Also, let your eye doctor know about any medications you take, including non-prescription vitamins, herbs and supplements.

For more information on eye conditions and diseases, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.

Tips for Coping With Vision Loss

Many normal, age-related problems affecting vision can be addressed with practical solutions, such as extra lighting for reading recipes or tinkering with garage projects.

In fact, after about age 60, you may find you need additional illumination for most tasks performed indoors or in darker conditions outdoors. This is because your eye's pupil no longer opens as widely as it once did to allow light to enter. Because less light is reaching your retina where vision processing occurs, images are no longer as sharp as they once were.

To help offset this problem, you might consider extra steps such as:

  • Installing task lighting underneath kitchen cabinets or above stoves to help illuminate darker corners.
     
  • Making sure you have enough lighting to brighten work surfaces in your garage, sewing room or other areas where you need to see fine details.
     
  • Asking your employer to install additional lighting, if needed, at your work space.

Also, make sure you have regular eye exams that include critical tests for older eyes to rule out potentially serious age-related eye diseases that may affect vision quality. Your eye doctor also can advise you about the best vision correction options to reduce the effects of normal age-related declines in near vision, color vision and contrast sensitivity.

Cataracts, which are very common in the over-60 age group, also can cause cloudy or hazy vision. Cataracts usually are easily remedied with surgery that removes the eye's cloudy lens and replaces it with an artificial one.

What can you do about permanent vision loss?

Unfortunately, some serious vision losses are due to blind spots caused by age-related eye diseases including glaucoma, advanced macular degeneration and diabetic retinopathy.

Many low vision devices are available for people with permanent vision loss, to assist them with daily living tasks. These devices include:

  • Strong magnifying lenses with extra illumination, for reading and other near vision work.
  • Audio tapes, specially adapted computer or television screens, and telescopes. 
  • Lens filters and shields to reduce glare.

Vision loss and the elderly

One disturbing trend noted in recent years has been an increased tendency in our society to overlook or neglect the vision correction needs of elderly citizens, including those living in nursing homes.

As an example, researchers say almost one third of older Americans diagnosed with glaucoma receive no treatment for this potentially blinding eye disease.

Consequences of delaying vision correction or needed treatment, especially in elderly people, can be severe. Uncorrected vision problems can contribute to falls that seriously injure elderly people and greatly reduce their confidence in their ability to live independently.

If you have older relatives or friends living alone or in a nursing home, consider serving as their advocate to make sure they receive appropriate vision care and treatment of age-related eye diseases, to maximize their quality of life.

For more information on low vision, visit All About Vision®.

Article ©2008 Access Media Group LLC.  All rights reserved.  Reproduction other than for one-time personal use is strictly prohibited.